Fee Schedules

2021 Medicare Physician Fee Schedule Slashes Lab Reimbursements 5% but Provides Some PAMA Relief

On Aug. 3, CMS released the proposed Medicare Physician Fee Schedule (PFS) rule for 2021. Bottom line on top: The agency is slashing lab reimbursement rates. Here are the four key takeaways for labs. … [Read more...]

Medicare Reimbursement

The 4 Things Labs Need to Know about CMS’ Newly Proposed 2021 OPPS Rule 

On Aug. 4, CMS posted the proposed Outpatient Prospective Payment System (OPPS) Rule for 2021.  In case you don’t feel like reading all 785 pages of the Rule, here’s a high level summary of the four … [Read more...]

New Laws

January 1, 2021 Is D-Day for Hospital Pricing Transparency 

It appears to be full speed ahead for hospital price transparency. The controversial effort to make hospitals divulge information about their healthcare pricing, including lab procedures, is very much … [Read more...]

OIG Watch

Agency to Review First Two Years of PAMA-Based Medicare Reimbursements for Lab Tests

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

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

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

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?

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

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

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...]


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