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...]
CO-ORDINATING DATA
Laboratory Information Systems (LIS): What You Need To Know To Get Paid
September 30, 2019
By Sean McSweeney bio Today, laboratory billing claims require more and more data to successfully get paid. One of the biggest reasons your claims may be getting denied is because you're not … [Read more...]
FEE SCHEDULES
Medicare Reimbursement: CMS Publishes New CPT Codes
September 3, 2019
CMS recently published new CPT codes taking effect on Oct. 1, 2019. All the codes have a Type of Service (TOS) code of 5, and the codes are contractor-priced until they appear on the Jan. 1, 2020 CLFS … [Read more...]
REIMBURSEMENT
PAMAgeddon: Congress Tables Bill to Delay Next Round of Price Reporting for One Year
July 16, 2019
The PAMA data collection process has been a lightning rod for criticism from almost the moment CMS unveiled it. And now Congress may be getting ready to intervene. A newly proposed bill called … [Read more...]
COVERAGE
Medicare Coverage: NGS Testing of Early-Stage Cancer Patients Is Back in Play
June 17, 2019
The reimbursement outlook for those who provide next generation sequencing (NGS) testing to early-stage cancer of Medicare patients with hereditary risks is far brighter today than it was a few weeks … [Read more...]
PAYER CONTRACTS
Three key items to negotiate for successful payer contracts
April 8, 2019
By Steve Selbst bio The purpose of this article is to help you, as a provider, to focus on three key items to look for in payer contracts that will help you to get profitable contracts in … [Read more...]
REIMBURSEMENT
The Newest PAMA Controversy: The GAO Report & Intervention of a Powerful Senator
March 25, 2019
The recent moves by CMS to include certain hospital outreach labs as "applicable laboratories" for purposes of PAMA reporting and pricing (see National Intelligence Report (NIR), Dec. 31, 2018) has … [Read more...]
FOCUS ON
Medicare Reimbursement: New Guidance on Date of Service Rules for Part B Billing of Hospital Outpatient Lab Tests
February 19, 2019
In 2018, new date-of-service rules took effect for billing and coding of outpatient lab tests under Medicare Part B, rather than as part of the Hospital Outpatient Prospective Payment System (HOPPS) … [Read more...]
CORRECTION
Correction: PAMA Relief—CMS 1450 14x TOB Labs DO Count!
December 20, 2018
Two articles appearing on the G2 website, "CMS Offers Some PAMA Relief But Not Nearly Enough" (G2 Compliance Advisor/Lab Compliance Advisor) and "2019 CLFS Offers Some PAMA Relief But Not Nearly … [Read more...]
