Normally among the slowest payors to accept promising but unproven new tests, Medicare continues to loosen the reins for molecular assays. In May, Palmetto GBA (Columbia, SC), one of Medicare's most … [Read more...]
BILLING & CODING
Reimbursement Trends: 5 More New Molecular Tests Get the Medicare Green Light from Palmetto
June 14, 2017
FEE SCHEDULES
CORRECTION: Molecular Assays Stave Off Big Cuts in 2017 Clinical Laboratory Fee Schedule
May 17, 2017
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...]
REIMBURSEMENT
LCDs Demonstrate Evolving Coverage of Molecular Diagnostics
January 23, 2017
Advanced diagnostic tests are emerging faster than the clinicians can document their clinical utility. All of this creates an interesting dilemma for payors as far as coverage is concerned. Normally … [Read more...]
REIMBURSEMENT
4 Things about the OPPS Final Rule That Labs Need to Know
November 25, 2016
On Nov. 14, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register the Medicare Hospital Outpatient Prospective Payment System (OPPS) final rule for 2017. In case you … [Read more...]
REIMBURSEMENT
OIG Report Details Medicare Payments for Top Lab Tests
November 7, 2016
Medicare Part B paid $7 billion for lab tests in 2015, the same amount it shelled out in 2014. But 2015 Medicare payments for the top 25 lab tests dipped slightly to $4.1 billion, as compared to $4.2 … [Read more...]
PAMA
OIG Surveys How CMS is Doing on PAMA Implementation
October 28, 2016
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
September 29, 2016
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...]
REIMBURSEMENT
Proposed Episode Payment Model for Cardiac Conditions, Fractures Could Impact Labs
September 20, 2016
The Centers for Medicare & Medicaid Services (CMS) recently released the proposed rule Advancing Care Coordination through Episode Payment Models for three conditions—acute myocardial infarction … [Read more...]
REIMBURSEMENT
CMS to Expand Episode Payment Models for Cardiac Conditions, Fractures
September 15, 2016
The Centers for Medicare & Medicaid Services (CMS) recently released the proposed rule Advancing Care Coordination through Episode Payment Models for three conditions—acute myocardial infarction … [Read more...]
FEE SCHEDULES
Are Commercial Payers Using Proposed CMS Gapfill Rates to Ratchet Down Reimbursement?
September 15, 2016
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...]
