CMS Repeals Rule Providing Expedited Medicare Coverage for MCIT “Breakthrough” Devices

It’s official. On Nov. 12, the US Centers for Medicare and Medicaid Services (CMS) announced that it was repealing a Trump administration final rule that, effective Dec. 15, 2021, would have expedited … [Read more...]


CMS Delays Payer-to-Payer Data Exchange but Prior Authorization Rules Remain on Track

On Sept. 17, the Centers for Medicare & Medicaid Services (CMS) announced that it’s delaying an interoperability rule governing how payors are expected to exchange with one another. However, the … [Read more...]

Compliance Alert

OIG Calls on CMS to Recover Phlebotomy Travel Allowance Overpayments

If your lab bills Medicare for phlebotomy travel allowances, a Medicare Administrative Contractor (MAC) claims audit may be in your future. The threat stems from a new Office of Inspector General … [Read more...]


Biden Pulls Plug on Automatic Medicare Coverage for MCIT “Breakthrough” Devices

In a reminder of why politics and presidential elections matter so much, the Biden administration announced that it’s scrapping a Trump regulation that would have automatically provided initial … [Read more...]

Independent Labs

CMS Clarifies IDTF Billing, Coding and Coverage Rules

In September, the Centers for Medicare & Medicaid Services (CMS) issued new guidance making some important clarifications on Independent Diagnostic Testing Facility (IDTF) billing requirements. … [Read more...]


New LCD Expanding Medicare Coverage for Circulating Tumor Cells Tests Is a Win for Biocept

Biocept announced that it has received expanded Medicare coverage for use of its Target Selector assay to identify HER-2 positive circulating tumor cells under a final CMS local coverage determination … [Read more...]


CMS Couldn’t Verify Hospital Safety During COVID and Won’t Be Able to Do So in Next Pandemic

CMS was unable to determine whether hospitals were maintaining quality and safety standards during the COVID-19 crisis. And unless changes are made to its regulatory powers, it won’t be able to make … [Read more...]

Coding Alert

CMS Adds New PLA Oncology, ELISA, Reproductive Codes to HCPCS

CMS added seven new PLA codes to the HCPCS files, effective July 1, 2021, which will be contractor-priced based on local rates until they undergo the CLFS annual payment determination process for … [Read more...]

Increasing Revenue

Manufacturers Wait Anxiously for CMS Decision on Automatic Medicare Coverage of MCIT Breakthrough Devices

Makers of innovative medical devices makers will remain on pins and needles after CMS’s decision to once more delay a final rule that would automatically provide initial Medicare coverage for new … [Read more...]


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...]