Last April, CMS issued a proposed rule to make Medicare rates more transparent. While designed to "empower patients and reduce administrative burden," the proposed changes would literally come at a … [Read more...]
HEALTH CARE REFORM
Medicare Reimbursement: How CMS Price Transparency Proposal Could Hurt Labs & Patient Relations
September 24, 2018
REIMBURSEMENT
PAMA: OIG Backing of CMS Heats Up Market-Based Lab Rates Controversy
September 24, 2018
CMS did it right and saved Medicare a boatload of money in the process, concludes a new OIG report reviewing the methods CMS used to establish "market-based" rates for Medicare Part B lab tests. Of … [Read more...]
PAMA
Proposed 2019 Medicare PFS: The 5 Things Labs Need to Know
September 14, 2018
On July 12, CMS issued the proposed 2019 Medicare physician fee schedule (PFS), with comments scheduled to end on Sept. 10. Takeaways: 1. Physician Payment Rates CMS is proposing a 0.25% increase … [Read more...]
REIMBURSEMENT
AAB and NILA comments allege unlawful implementation of PAMA by CMS
September 13, 2018
The National Independent Laboratory Association (NILA) and the American Association of Bioanalysts (AAB) has formally commented to the Centers for Medicare and Medicaid Services (CMS) that the agency … [Read more...]
PAMA
Proposed 2019 Medicare HOPPS Rule: The 4 Things Labs Need to Know
September 5, 2018
Heads up to labs that bill Medicare for services to hospital outpatients: CMS issued the proposed 2019 hospital Outpatient Prospective Payment System (OPPS) on July 25, with comments scheduled to end … [Read more...]
FEE SCHEDULES
OIG Backs CMS on PAMA Market Rate Setting—and the Lab Industry Is None Too Pleased
August 27, 2018
CMS did it right and saved Medicare a boatload of money in the process, concludes a new OIG report examining the agency's work in carrying out its PAMA mandate of establishing market-based Medicare … [Read more...]
REIMBURSEMENT
Proposed 2019 OPPS Rule Includes Site-Neutral Payment, Other Changes
August 22, 2018
On July 25, CMS released its proposed Medicare Outpatient Prospective Payment System (OPPS) proposed rule for calendar year 2019. Here are the four takeaways for labs. 1. 1.25% Rate Increase CMS … [Read more...]
REIMBURSEMENT
Medicare Reimbursement: CMS Proposes 2019 Physician Fee Schedule
August 21, 2018
On July 12, CMS issued its proposed Medicare physician fee schedule (PFS) rule for calendar year 2019. Although not yet finalized, the proposed Part B policy changes are sweeping and worth reviewing … [Read more...]
ENFORCEMENT
CMS Takes 3 New Measures to Bolster Medicaid Program Integrity
August 20, 2018
With Medicaid spending on the rapid ascent, CMS unveiled a trio of new initiatives to bolster program integrity and make states more accountable for compliance with federal rules. 1. MLR Audits CMS … [Read more...]
STARK LAW
Brief Your CEO: Real Stark Law Relief Might Actually Happen
August 13, 2018
Fool me once, shame on you; fool me twice, shame on me. That may have been your reaction when you first heard about the new CMS Request for Information (RFI) seeking input on ways to alleviate the … [Read more...]
