Date of service rules affect whether outpatient lab tests are part of the Hospital Outpatient Prospective Payment System (HOPPS) bundled payment or can be billed separately under Part B. Last month, … [Read more...]
OUTPATIENT PAYMENTS
How to Determine Date of Service for Part B Billing of Outpatient Lab Tests
March 15, 2019
COMPLIANCE PERSPECTIVES
Compliance Perspectives: CMS Reviews PAMA Reporting Basics for Hospital Outreach Labs
February 25, 2019
PAMA reporting is tricky business in which mistakes and omissions carry the risk of civil monetary penalties of up to $10,000 per day. So, whether you're with a freestanding lab that's been through … [Read more...]
CLIA
After Nearly 3 Decades, CMS Proposes Updates to Proficiency Testing Rules
February 22, 2019
When the CLIA (the Clinical Laboratory Improvement Amendments of 1988) proficiency testing (PT) regulations were first implemented in 1992, George H.W. Bush was President, gas cost about $1.05 per … [Read more...]
REIMBURSEMENT
Medicare Reimbursement: CMS Limits NGS Early Cancer Test Coverage but Industry Fires Back
February 22, 2019
Getting Medicare to cover Next Generation Sequencing (NGS) tests has been a slow go. And the latest CMS National Coverage Determination (NCD) for early stage cancer NGS testing of patients with … [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...]
CMS
CLIA: CMS Proposes 20% Fee Increase—and Further Increases Could Follow
January 28, 2019
As if Year 2 of PAMA lab fees wasn't enough, CMS dished out another dose of agita to the lab industry: CLIA fees will be going up 20%, effective this year. Background For those of you who are new to … [Read more...]
NEWS
Government Shutdown: The Impact on the Agencies that Regulate Labs
January 23, 2019
As we go to press, the longest U.S. government shutdown in history drags on with no end in sight. And while it may not affect your lab directly, the shutdown will have an indirect impact to the extent … [Read more...]
COMPLIANCE PLANS
OIG Monthly Work Plan Review: January 2019
January 23, 2019
This month, there were six new Work Plan items. The two pertaining to labs are detailed below. The first one has widespread implications for labs; the second may have implications for some labs 1. … [Read more...]
PAMA
Medicare Reimbursement: CMS Provides Needed PAMA Relief—But Newly Covered Hospital Labs Must Report in 2019
January 21, 2019
The battle between CMS and the lab industry over Medicare Part B pricing for lab tests could be on the road to resolution notwithstanding the ACLA's recent court loss. But even as the legal battle … [Read more...]
ENFORCEMENT
Provider Fined for Not Taking Compliance Measures Required by Its CIA
January 19, 2019
Case: Nearly 10 years ago, a new Affordable Care Act rule requiring labs and other providers to investigate their credit balances for potential Medicare overpayments took effect. In 2015, Pediatric … [Read more...]
