Even though PAMA has slashed reimbursement rates for many tests, overall Medicare Part B spending on lab tests continues to increase.
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Here’s a look at what labs need to know about the new rules that take effect on Jan. 1 as part of the 2023 Medicare Physician Fee Schedule.
Labs will be able to bill Medicare and Medicaid for these new CLIA-waived tests, starting on April 1, 2023.
The final Outpatient Prospective Payment System Final Rule for 2023 provides for a rate increase of nearly four percent.
Despite Congress’ clear policy on private insurer payment of COVID-19 tests, many labs have been struggling to get reimbursed.
CMS has instructed its MACs to recognize eight new CLIA-waived complexity tests for which labs will be allowed to bill, effective Oct. 1.
As of August 31, 2022, labs and other providers must use the new ABN labeled with the appropriate federal OMB Number (0938-0566) and CMS-R-131 to ensure they can bill Medicare beneficiaries for any lab tests or other services that Medicare doesn’t cover.
According to a recent OIG report, CMS is not doing a good job collecting the Medicare overpayments OIG auditors are uncovering. However, CMS recently rejected almost all of the recommendations in that report, suggesting all is not well between the two federal agencies.
The new report could be a turning point in the battle to curb payor abuse of preauthorization requirements.
Here are the two key CLFS changes, set to take effect on July 1, 2022, that your billing staff needs to know about.