As we pass the midpoint of the third year of the PAMA experiment—if that’s what it is—the OIG announced plans to review what happened in years one and two. One of the new items on the agency’s Work … [Read more...]
PAMA: The New LAB Act Buys Labs One Year of Price Reporting Relief
January 13, 2020
The lab industry has been making slow but steady progress in its quest for PAMA relief. After winning a federal court appeal preserving its right to challenge CMS’s PAMA pricing systems, the industry … [Read more...]
CMS
Hospital Labs: CMS Pushes Forward with Controversial Price Transparency Rules
January 2, 2020
Brushing aside the intense objections and negative feedback, CMS pressed forward with price transparency by including as part of the 2020 Outpatient Prospective Payment System final rules the … [Read more...]
FEE SCHEDULES
Medicare Reimbursement: CMS Publishes New CPT Codes
September 3, 2019
CMS recently published new CPT codes taking effect on Oct. 1, 2019. All the codes have a Type of Service (TOS) code of 5, and the codes are contractor-priced until they appear on the Jan. 1, 2020 CLFS … [Read more...]
OIG OPINION
Is Your Billing Company Putting You At Compliance Risk?
August 5, 2019
By Sean McSweeney bio Does your orthopedic billing company charge a percentage of collections for their coding and billing? They might break out separate charges for statements or other … [Read more...]
PAYER CONTRACTS
Three key items to negotiate for successful payer contracts
April 8, 2019
By Steve Selbst bio The purpose of this article is to help you, as a provider, to focus on three key items to look for in payer contracts that will help you to get profitable contracts in … [Read more...]
FOCUS ON
Medicare Reimbursement: New Guidance on Date of Service Rules for Part B Billing of Hospital Outpatient Lab Tests
February 19, 2019
In 2018, new date-of-service rules took effect for billing and coding of outpatient lab tests under Medicare Part B, rather than as part of the Hospital Outpatient Prospective Payment System (HOPPS) … [Read more...]
REIMBURSEMENT
Labs Need to Prepare for Upcoming PAMA Data Collection Period
October 30, 2018
The impact of PAMA (the Protecting Access to Medicare Act) is already being felt in the laboratory industry. The estimates are bleak. Three-fourths of codes on the Clinical Lab Fee Schedule are now … [Read more...]
REIMBURSEMENT
Proposed 2019 OPPS Rule Includes Site-Neutral Payment, Other Changes
August 22, 2018
On July 25, CMS released its proposed Medicare Outpatient Prospective Payment System (OPPS) proposed rule for calendar year 2019. Here are the four takeaways for labs. 1. 1.25% Rate Increase CMS … [Read more...]
REIMBURSEMENT
Medicare Reimbursement: CMS Proposes 2019 Physician Fee Schedule
August 21, 2018
On July 12, CMS issued its proposed Medicare physician fee schedule (PFS) rule for calendar year 2019. Although not yet finalized, the proposed Part B policy changes are sweeping and worth reviewing … [Read more...]
