Billing & Coding Alert

CMS Recognizes 3 New CLIA-Waived (CW) Tests

CMS announced three new CLIA-waived complexity tests that labs will be allowed to bill to Medicare, effective January 3, 2022. Here are the key details you need to know to ensure maximum reimbursement … [Read more...]


Congress Acts to Delay 2022 PAMA Price Cuts at the Eleventh Hour

Dec. 2 was a disappointing day for the lab industry when Congress passed a stopgap spending bill without a provision that would have delayed the upcoming 2022 PAMA price cuts. After dodging a bullet … [Read more...]

Medicare Reimbursement: The 5 Things Labs Need to Know about the 2022 Physician Fee Schedule

CMS issued the final rule setting out the Physician Fee Schedule (PFS) for 2022 and addressing other matters of Medicare Part B reimbursement on Nov. 2. Here’s a quick briefing on the five PFS changes … [Read more...]

Medicare Reimbursement

The 4 Things Labs Need to Know About the 2022 OPPS Payments Rule

On Nov. 2, CMS posted the final Outpatient Prospective Payment System (OPPS) Rule for 2022. If for some reason you don’t feel like reading all 1,394 pages of the Rule, here’s a high-level summary of … [Read more...]


CMS Repeals Rule Providing Expedited Medicare Coverage for MCIT “Breakthrough” Devices

It’s official. On Nov. 12, the US Centers for Medicare and Medicaid Services (CMS) announced that it was repealing a Trump administration final rule that, effective Dec. 15, 2021, would have expedited … [Read more...]


CMS Delays Payer-to-Payer Data Exchange but Prior Authorization Rules Remain on Track

On Sept. 17, the Centers for Medicare & Medicaid Services (CMS) announced that it’s delaying an interoperability rule governing how payors are expected to exchange with one another. However, the … [Read more...]


New LCD Expanding Medicare Coverage for Circulating Tumor Cells Tests Is a Win for Biocept

Biocept announced that it has received expanded Medicare coverage for use of its Target Selector assay to identify HER-2 positive circulating tumor cells under a final CMS local coverage determination … [Read more...]


CMS Proposes to Ease but Not End Hospital Price Transparency

If you’re a hospital lab administrator, you’ll probably be happy to learn that the Biden administration is proposing to repeal some of the more troublesome Trump price transparency rules relating. But … [Read more...]

Billing and Coding

OIG Calls on CMS to Crack Down on Improper Payment of Definitive Drug and LDL Cholesterol Tests

History tells us that whenever OIG issues a report pointing out a pattern of Medicare Part B overpayments for lab tests, labs and physicians that provide those tests should be concerned. In recent … [Read more...]

Utilization Management

Congress Moves to Limit Prior Authorization Protocols of Medicare Advantage Plans

Prior authorization has been a perennial source of friction between payors and providers. While payors have a legitimate need to ensure program integrity and manage utilization of covered health … [Read more...]