On Aug. 4, CMS posted the proposed Outpatient Prospective Payment System (OPPS) Rule for 2021. In case you don’t feel like reading all 785 pages of the Rule, here’s a high level summary of the four … [Read more...]
Compliance Alert
OIG Targets COVID-19 Test Labs for Potential Add-on Testing Abuses
July 20, 2020
Are labs taking advantage of the unprecedented demand for COVID-19 testing to bill Medicare for high reimbursing and medically unnecessary add-on tests? That’s what the OIG suspects and it plans to … [Read more...]
COVID-19 Relief
HHS Clarifies Rules for Receipt of Provider Relief Fund Payments
May 27, 2020
If like so many other providers trying to survive COVID-19 business disruption, your lab is getting federal CARES relief payments, you need to be aware of the recent rule changes announced by HHS. … [Read more...]
CARES Act
CMS Issues Guidance on Private Payor Reimbursement of COVID-19 Testing
May 24, 2020
If your lab is performing COVID-19 testing for patients covered by private insurance and health plans, you need to be aware of the reimbursement rules set out in the new COVID-19 relief legislation. … [Read more...]
Billing & Coding
New HCPCS Codes for COVID-19 Specimen Collection
April 16, 2020
CMS has established two new Level II HCPCS codes for COVID-19 specimen collection: G2023 - Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus … [Read more...]
PAMA
COVID-19 Relief Bill Defers 2021 Medicare Part B Lab Test Price Cuts for One Year
April 14, 2020
The $2 trillion COVID-19 relief bill, CARES (Coronavirus Aid, Relief and Economic Security Act), provides for free coronavirus testing without adequately compensating the labs who perform the tests. … [Read more...]
REIMBURSEMENT
By the Numbers: Improper Medicare Payments Hit 10-Year Low
January 13, 2020
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
January 2, 2020
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
January 2, 2020
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...]
