CMS

Medicare Reimbursement: CMS Proposes MACRA Physician Performance Requirements for 2018

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...]

HEALTH CARE REFORM

Labs to CMS: Push Back PAMA & Add Hospital Labs to CLFS Mix

The lab industry continues to wait nervously for word from CMS regarding PAMA. Demand 1: Fix the Fee Schedule Methodology The industry's paramount concern remains the formula CMS proposes to use to … [Read more...]

FEE SCHEDULES

CORRECTION: Molecular Assays Stave Off Big Cuts in 2017 Clinical Laboratory Fee Schedule

  Editor's Note: The lead story in the November 25, 2016 issue of LIR is about changes to the 2017 Clinical Laboratory Fee Schedule affecting reimbursement for clinical laboratory tests. The … [Read more...]

FEE SCHEDULES

Crosswalked Codes in 2017 Clinical Laboratory Fee Schedule

CPT Code Crosswalked To 80305 (Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (e.g., immunoassay) capable of being read by direct optical … [Read more...]

PAMA

OIG Surveys How CMS is Doing on PAMA Implementation

With D-day set for Jan. 1, 2018 for implementation of a new payment methodology for lab services under the Protecting Access to Medicare Act of 2014 (PAMA), the Office of Inspector General (OIG) just … [Read more...]

CMS

PAMA Update: CMS Guidance and Reporting Information Trickles In

The Centers for Medicare & Medicaid Services (CMS) promised more details would be coming once it released the final rule implementing the Protecting Access to Medicare Act of 2014 (PAMA) this past … [Read more...]

FEE SCHEDULES

Are Commercial Payers Using Proposed CMS Gapfill Rates to Ratchet Down Reimbursement?

During the summer, the Centers for Medicare & Medicaid Services (CMS) published proposed interim gapfill prices for 15 molecular tests. The agency said it would likely publish final prices later … [Read more...]

FEE SCHEDULES

CMS Proposes Pathology, Cytology Cuts for 2017 Physician Fee Schedule

CPT Code 88305 is headed to the chopping block again. The Centers for Medicare & Medicaid Services (CMS) has suggested cutting the technical component of 88305—a tissue examination and a primary … [Read more...]

PAMA

The PAMA Snag: Many Hospital Labs May Not Be Able to Participate in Reporting

When the Centers for Medicare & Medicaid Services (CMS) announced in mid-June the final rules governing the Protecting the Access to Medicare Act (PAMA), it drew praise from several groups that … [Read more...]

REIMBURSEMENT

Reimbursement for Molecular Testing Faces Cuts in CMS’ Proposed Gapfill Prices

The Centers for Medicare & Medicaid Services (CMS) published interim gapfill prices last month for new CPT codes for molecular tests introduced earlier this year. Although the pricing was for a … [Read more...]


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