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...]
BILLING & CODING
Medicare Reimbursement: CMS Begins Implementing New HOPPS Date of Service Rules for ADLTs & Molecular Pathology Tests
July 13, 2018
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...]
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...]
FOCUS ON
Emerging Tests: Medicare to Cover Next Gen-Sequencing Tests for Advanced Cancer
April 30, 2018
In the PAMA era, there are two salient trends in Medicare Part B lab reimbursements: Sharply lower prices for traditional tests; and Wider coverage of newly emerging tests, including some that … [Read more...]
SAFETY
Diagnostic danger in the lab: Time to reform how we process orders
April 16, 2018
By Oleg Bess, M.D. bio I don't know about you, but I was stunned by the findings from a recent report published by Coverys, a national liability insurer, which I feel should put the entire … [Read more...]
REIMBURSEMENT
Out of Network: 6 Frequently Asked Questions
March 19, 2018
By Richa Singh bio As labs face an increasingly challenging reimbursement environment, more providers are doubling down on out-of-network strategies to maximize on collections … [Read more...]
DRUG TESTING
Part B Reimbursement: OIG Flags $66.3 Million in Improper Urine Specimen Validity Test Payments
March 16, 2018
These are tense times for providers of urine drug tests for Medicare and Medicaid patients. And on Feb. 20, the hot seat got even hotter with the issuance of a new OIG report saying CMS made $66.3 … [Read more...]
INSURERS & PAYORS
Test Ordering & Utilization: Labs Stand to Benefit from Industry Efforts to Minimize Prior Authorization Red Tape
March 16, 2018
Although not specifically directed at labs, a new collaboration between the American Medical Association and insurance giant Anthem may offer solutions to a perennial thorn in the side of labs: payor … [Read more...]
FOCUS ON
Medicare Reimbursement: CMS Launches New LVA Process for Settling Payment Appeals
March 12, 2018
While Part B lab reimbursements may be going down, the good news is that it just became easier to challenge Medicare payment denials. Here is an overview of the new CMS Low Volume Appeals settlement … [Read more...]
