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...]

HEALTH CARE REFORM

Labs to CMS: Push Back PAMA & Add Hospital Labs to CLFS Mix

The lab industry continues to wait nervously for word from CMS regarding PAMA. Demand 1: Fix the Fee Schedule Methodology The industry's paramount concern remains the formula CMS proposes to use to … [Read more...]

BILLING & CODING

Reimbursement Trends: 5 More New Molecular Tests Get the Medicare Green Light from Palmetto

Normally among the slowest payors to accept promising but unproven new tests, Medicare continues to loosen the reins for molecular assays. In May, Palmetto GBA (Columbia, SC), one of Medicare's most … [Read more...]

FEE SCHEDULES

CORRECTION: Molecular Assays Stave Off Big Cuts in 2017 Clinical Laboratory Fee Schedule

  Editor's Note: The lead story in the November 25, 2016 issue of LIR is about changes to the 2017 Clinical Laboratory Fee Schedule affecting reimbursement for clinical laboratory tests. The … [Read more...]

REIMBURSEMENT

LCDs Demonstrate Evolving Coverage of Molecular Diagnostics

Advanced diagnostic tests are emerging faster than the clinicians can document their clinical utility. All of this creates an interesting dilemma for payors as far as coverage is concerned. Normally … [Read more...]


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