BILLING

OIG Work Plan Targets Medicare Part B Billing & Payment of Lab Tests

During the Public Health Emergency (PHE), the Department of Health and Human Services (HHS) has cut labs extraordinary slack in the form of waivers that temporarily loosen Medicare test coverage rules … [Read more...]

PRICE TRANSPARENCY

CMS Proposes to Ease but Not End Hospital Price Transparency

If you’re a hospital lab administrator, you’ll probably be happy to learn that the Biden administration is proposing to repeal some of the more troublesome Trump price transparency rules relating. But … [Read more...]

REIMBURSEMENT

Ensure Proper Billing of New FDA-Approved CLIA-Waived Tests

Reminder: Effective July 1, labs can bill Medicare for a number of new CLIA-waived tests approved by the FDA. Here are the key details you need to know to ensure maximum reimbursement and proper … [Read more...]

Billing and Coding

OIG Calls on CMS to Crack Down on Improper Payment of Definitive Drug and LDL Cholesterol Tests

History tells us that whenever OIG issues a report pointing out a pattern of Medicare Part B overpayments for lab tests, labs and physicians that provide those tests should be concerned. In recent … [Read more...]

Reimbursement

CMS Proposes to Ease, but Not End Hospital Price Transparency

If you’re a hospital lab administrator, you’ll probably be happy to learn that the Biden administration is proposing to repeal some of the more troublesome Trump price transparency rules relating. But … [Read more...]

Reimbursement

MCIT Medicare Coverage Rule Could Be Reimbursement “Breakthrough” for Makers of LDTs

Medical device makers and members of Congress are growing impatient as CMS sends signals of still further delay on a final decision on a final rule that would automatically provide initial Medicare … [Read more...]

Reimbursement

OIG Sounds the Warning on Improper COVID-19 Vaccination Billing

Labs and providers that furnish COVID-19 testing and vaccination services need to look ahead and prepare for the massive federal false billing crackdown that is sure to come if and when the pandemic … [Read more...]

PAMA

MedPAC Explores Simplified PAMA Reporting to Cut Burdens & Restore Lab Prices

The upcoming report of the Medicare Payment Advisory Commission (MedPAC) gives the lab industry new hopes for relief from the administrative burdens of Protecting Access to Medicare Act of 2014 (PAMA) … [Read more...]

CPT Coding

AMA Creates New PLA Code 0247U for Sera Prognostics PreTRM Test

The most recent laboratory developed test (LDT) to garner CPT code recognition from the American Medical Association (AMA) is Sera Prognostics, Inc.’s PreTRM Test, a proteomic blood test for measuring … [Read more...]

HHS

Hospital Price Transparency Is Here—But How Will It Be Enforced?

With just three days left in 2020, last-ditch efforts to derail HHS’ controversial new hospital transparency rules before they took effect on Jan. 1 failed when the U.S. Court of Appeals for the … [Read more...]


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