REIMBURSEMENT

By the Numbers: Improper Medicare Payments Hit 10-Year Low

As 2019 came to an end, CMS announced that the rate of improper Medicare payments during the year continued to decline, hitting its lowest point since 2010. Here are some of the key numbers: … [Read more...]

Genetic Testing: CMS Proposes Expanding NGS Testing Eligibility

In a reversal, CMS is now proposing to cover FDA-approved or -cleared germline NGS testing for breast and ovarian cancer patients who have risk factors that suggest they should receive testing to … [Read more...]

CMS

Hospital Labs: CMS Pushes Forward with Controversial Price Transparency Rules

Brushing aside the intense objections and negative feedback, CMS pressed forward with price transparency by including as part of the 2020 Outpatient¬†Prospective Payment System final rules the … [Read more...]

CO-ORDINATING DATA

Laboratory Information Systems (LIS): What You Need To Know To Get Paid

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 not … [Read more...]

FEE SCHEDULES

Medicare Reimbursement: CMS Publishes New CPT Codes

CMS recently published new CPT codes taking effect on Oct. 1, 2019. All the codes have a Type of Service (TOS) code of 5, and the codes are contractor-priced until they appear on the Jan. 1, 2020 CLFS … [Read more...]

REIMBURSEMENT

PAMAgeddon: Congress Tables Bill to Delay Next Round of Price Reporting for One Year

The PAMA data collection process has been a lightning rod for criticism from almost the moment CMS unveiled it. And now Congress may be getting ready to intervene. A newly proposed bill called … [Read more...]

COVERAGE

Medicare Coverage: NGS Testing of Early-Stage Cancer Patients Is Back in Play

The reimbursement outlook for those who provide next generation sequencing (NGS) testing to early-stage cancer of Medicare patients with hereditary risks is far brighter today than it was a few weeks … [Read more...]

PAYER CONTRACTS

Three key items to negotiate for successful payer contracts

By Steve Selbst  bio The purpose of this article is to help you, as a provider, to focus on three key items to look for in payer contracts that will help you to get profitable contracts in … [Read more...]

REIMBURSEMENT

The Newest PAMA Controversy: The GAO Report & Intervention of a Powerful Senator

The recent moves by CMS to include certain hospital outreach labs as "applicable laboratories" for purposes of PAMA reporting and pricing (see National Intelligence Report (NIR), Dec. 31, 2018) has … [Read more...]

FOCUS ON

Medicare Reimbursement: New Guidance on Date of Service Rules for Part B Billing of Hospital Outpatient Lab Tests

In 2018, new date-of-service rules took effect for billing and coding of outpatient lab tests under Medicare Part B, rather than as part of the Hospital Outpatient Prospective Payment System (HOPPS) … [Read more...]


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