FOCUS ON

PAMA Implementation: PLA Codes for Advanced Dx Tests Are Off to a Flying Start

PAMA implementation is so sweeping that it requires a shift in not just payment paradigm but also CPT codes. This has served as the impetus for development of a new class of codes known as … [Read more...]

CMS

OPPS 2018: Revised Payment Rates & a New ADLT Date of Service Exemption

With all of the PAMA commotion, CMS's publication of the 2018 Medicare Hospital and Ambulatory Surgical Outpatient Prospective Payment System (OPPS) final rule has flown under the radar. In case you … [Read more...]

REIMBURSEMENT TRENDS

Billing & Coding: Proposed New Molecular Pathology Crosswalk Codes for 2018

The newly proposed 2018 Clinical Laboratory Fee Schedule includes over 130 crosswalked CPT codes, including roughly 30 new codes for molecular pathology tests. New Crosswalked Molecular Pathology … [Read more...]

MEDICARE COVERAGE

Medicare Reimbursements: Part B Lab Payments Slightly Down for 2016, Reports OIG

The OIG released its report on Medicare Part B payments for lab tests in 2016. The punchline: Lab payments over the past three years remain incredibly consistent in terms of both amount and … [Read more...]

FEE SCHEDULES

Newly Proposed PAMA Rates for 2018 Confirm Lab Industry’s Worst Fears

CMS's newly issued preliminary Clinical Laboratory Fee Schedule (CLFS) for 2018 dashes the lab industry's hopes for PAMA relief by making two things painfully clear: There will be no delay in plans … [Read more...]

TRICARE

LDTs: TRICARE Beneficiaries Get At Least 3 More Years of Access

Some of the labs that participate in TRICARE got some good news when the Department of Defense announced that it has extended the so called Approved Laboratory Developed Tests (LDTs) Demonstration … [Read more...]

PAMA

Draft 2018 CLFS Reveals Fundamental Flaws in PAMA Reporting Exercise; Time to Take Action

By Lâle White  bio As XIFIN predicted, the PAMA reporting exercise has resulted in significant proposed laboratory fee cuts. In fact, the multi-year decrease for the top 20 laboratory tests … [Read more...]

COMPLIANCE

Enforcement Trends: Private Sector Playing a Bigger Role in Lab Fraud Crackdown

Laboratories have been on the receiving end of health care fraud allegations for decades. But while the risk of prosecution and litigation haven't changed, the dynamics have. Although federal … [Read more...]

MEDICARE COVERAGE

Reimbursement Trends: 8 Molecular Assays Score Big Coverage Wins from Medicare, Private Insurers

Molecular labs continue to gain ground with insurers. This summer, 8 more genetic assays received positive coverage decisions—4 from Medicare and 4 from private insurers. The winners included Genomic … [Read more...]

CMS

Medicare Reimbursement: CMS Proposes MACRA Physician Performance Requirements for 2018

On June 30, CMS issued a Proposed Rule addressing a key part of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) implementation: the Quality Payment Program (QPP) for 2018, the second … [Read more...]


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