BILLING & CODING

Medicare Reimbursement: CMS Begins Implementing New HOPPS Date of Service Rules for ADLTs & Molecular Pathology Tests

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...]

FEE SCHEDULES

How PAMA’s Effect in 2018 Molecular Diagnostic Reimbursement Will Make Labs More Money

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

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

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

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

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

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

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

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

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...]


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