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...]
PAMA
PAMA Unlocks Golden Age for Innovative Diagnostics
July 30, 2018
By Chance Scott bio The publication of the 2018 Clinical Laboratory Fee Schedule (CLFS) in January saw a long and heated debate within the lab community come to fruition. When Congress … [Read more...]
FEE SCHEDULES
How PAMA’s Effect in 2018 Molecular Diagnostic Reimbursement Will Make Labs More Money
June 25, 2018
By Sean McSweeney bio The year 2018 is slated to be much brighter for molecular diagnostic labs as PAMA fee schedules show a higher payment rate and amount for many cancer genomics and … [Read more...]
FEE SCHEDULES
PAMA Reimbursement: CMS Explains How to Get ADLT Status for New Lab Tests
June 11, 2018
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...]
