Medicare Reimbursement

The 4 Things Labs Need to Know about CMS’ Newly Proposed 2021 OPPS Rule 

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...]

New Laws

January 1, 2021 Is D-Day for Hospital Pricing Transparency 

It appears to be full speed ahead for hospital price transparency. The controversial effort to make hospitals divulge information about their healthcare pricing, including lab procedures, is very much … [Read more...]

Compliance Alert

OIG Targets COVID-19 Test Labs for Potential Add-on Testing Abuses

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

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

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

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

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

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

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

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...]


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