On Nov. 8, CMS posted Merit-based Incentive Payment System (MIPS) performance results for 2017, the first year of the Quality Payment Program (QPP) which it will use to determine 2019 Medicare … [Read more...]
FALSE CLAIMS
PAMA: ACLA Loses Court Lab Fees Battle But May Still Win Regulatory War
October 11, 2018
It was a long shot to begin with. But that doesn't ease the disappointment of what happened in a Washington, DC courtroom when a federal judge tossed a lab industry lawsuit challenging the legality of … [Read more...]
CMS
Reimbursement Trends: OIG Report Shows Slight Uptick in 2017 Medicare Part B Lab Payments
October 10, 2018
On Jan. 1, 2018, the new Medicare Part B PAMA Clinical Laboratory Fee Schedule (CLFS) in which lab test reimbursements are based on a single national fee lab schedule for lab tests rather than 57 … [Read more...]
REIMBURSEMENT
AAB and NILA comments allege unlawful implementation of PAMA by CMS
September 13, 2018
The National Independent Laboratory Association (NILA) and the American Association of Bioanalysts (AAB) has formally commented to the Centers for Medicare and Medicaid Services (CMS) that the agency … [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...]
BILLING & CODING
Medicare Reimbursement: CMS Begins Implementing New HOPPS Date of Service Rules for ADLTs & Molecular Pathology Tests
August 13, 2018
CMS has begun implementing the new rules that exempt advanced diagnostic laboratory tests (ADLTs) and molecular pathology tests from Medicare Hospital Outpatient Prospective Payment System (HOPPS) … [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...]
CO-ORDINATING DATA
Laboratory Information Systems (LIS): What You Need To Know To Get Paid
July 23, 2018
By Sean McSweeney bio Today, laboratory billing claims require more and more data to successfully get paid. One of the biggest reasons your claims may be getting denied is because you're … [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...]
REIMBURSEMENT
Enforcement Trends: OIG Report Suggests that Urine Drug Testing Is Making Labs a Juicy Target Once Again
June 19, 2018
The Office of Inspector General just published its Semiannual Report to Congress (covering Oct. 1, 2017 through March 31, 2018). Here are the key things labs and lab managers need to know about this … [Read more...]
