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...]
FOCUS ON
Emerging Tests: Medicare to Cover Next Gen-Sequencing Tests for Advanced Cancer
April 11, 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...]
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...]
FOCUS ON
Value Care: CMS Value Modifier Programs Ends Not with a Bang but a Whimper
March 5, 2018
Thanks for nothing. While CMS likes to congratulate itself for using provider pay adjustments to "transform the healthcare delivery system," more often than not, the rhetoric fails to live … [Read more...]
HEALTH CARE REFORM
Medicare Reimbursement: Federal Government Funding Extension Includes a Boatload of Medicare Changes
February 26, 2018
The government shutdown fiasco is having an impact on Medicare spending and reimbursement. But the crucial details are being buried in the legislative paperwork. So we decided to ferret them out for … [Read more...]
REIMBURSEMENT
Medicare Reimbursement: CMS Finalizes Controversial PAMA Fee Schedule
December 12, 2017
It's official. CMS is going forward with its controversial 2018 PAMA Clinical Laboratory Fee Schedule (CLFS). Regrettably, the final version closely tracks the preliminary one (See GCA, Oct. 24, 2017, … [Read more...]
PAMA
CMS Ignores Flawed Processes, Finalizes 2018 PAMA Pricing; Labs Need to Take Immediate Action to Offset Impending Lean Times
December 4, 2017
By Kyle Fetter bio The final 2018 clinical laboratory fee schedule (CLFS) is out, and it is evident that the argument that the Centers for Medicare & Medicaid Services (CMS) PAMA … [Read more...]
