Although the 2018 market-based Clinical Laboratory Fee Schedule (CLFS) is officially in effect, implementation of the new PAMA Part B payment rules for lab tests remains a work in progress. On March … [Read more...]
REIMBURSEMENT
Medicare Reimbursement: CMS Finalizes Controversial PAMA Fee Schedule
December 12, 2017
It's official. CMS is going forward with its controversial 2018 PAMA Clinical Laboratory Fee Schedule (CLFS). Regrettably, the final version closely tracks the preliminary one (See GCA, Oct. 24, 2017, … [Read more...]
PAMA
CMS Ignores Flawed Processes, Finalizes 2018 PAMA Pricing; Labs Need to Take Immediate Action to Offset Impending Lean Times
December 4, 2017
By Kyle Fetter bio The final 2018 clinical laboratory fee schedule (CLFS) is out, and it is evident that the argument that the Centers for Medicare & Medicaid Services (CMS) PAMA … [Read more...]
FOCUS ON
PAMA Implementation: PLA Codes for Advanced Dx Tests Are Off to a Flying Start
November 16, 2017
PAMA implementation is so sweeping that it requires a shift in not just payment paradigm but also CPT codes. This has served as the impetus for development of a new class of codes known as … [Read more...]
CMS
OPPS 2018: Revised Payment Rates & a New ADLT Date of Service Exemption
November 16, 2017
With all of the PAMA commotion, CMS's publication of the 2018 Medicare Hospital and Ambulatory Surgical Outpatient Prospective Payment System (OPPS) final rule has flown under the radar. In case you … [Read more...]
REIMBURSEMENT TRENDS
Billing & Coding: Proposed New Molecular Pathology Crosswalk Codes for 2018
October 23, 2017
The newly proposed 2018 Clinical Laboratory Fee Schedule includes over 130 crosswalked CPT codes, including roughly 30 new codes for molecular pathology tests. New Crosswalked Molecular Pathology … [Read more...]
MEDICARE COVERAGE
Medicare Reimbursements: Part B Lab Payments Slightly Down for 2016, Reports OIG
October 23, 2017
The OIG released its report on Medicare Part B payments for lab tests in 2016. The punchline: Lab payments over the past three years remain incredibly consistent in terms of both amount and … [Read more...]
FEE SCHEDULES
Newly Proposed PAMA Rates for 2018 Confirm Lab Industry’s Worst Fears
October 16, 2017
CMS's newly issued preliminary Clinical Laboratory Fee Schedule (CLFS) for 2018 dashes the lab industry's hopes for PAMA relief by making two things painfully clear: There will be no delay in plans … [Read more...]
PAMA
Draft 2018 CLFS Reveals Fundamental Flaws in PAMA Reporting Exercise; Time to Take Action
October 2, 2017
By Lâle White bio As XIFIN predicted, the PAMA reporting exercise has resulted in significant proposed laboratory fee cuts. In fact, the multi-year decrease for the top 20 laboratory tests … [Read more...]
CMS
Medicare Reimbursement: CMS Proposes MACRA Physician Performance Requirements for 2018
August 21, 2017
On June 30, CMS issued a Proposed Rule addressing a key part of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) implementation: the Quality Payment Program (QPP) for 2018, the second … [Read more...]
