Lying to a Medicare auditor or otherwise obstructing a Medicare audit is a crime that can get you jailed. A 73-year-old endocrinologist specializing in diabetes management just learned that lesson the … [Read more...]
ANTI-KICKBACK
Enforcement Trends: Feds Administer a Double Dose of Civil Monetary Penalty Increases
October 23, 2018
Potential penalties for Medicare violations will be higher if they're assessed on or after Oct. 11, 2018. That's when the newly announced Dept. of Health and Human Services' (HHS) inflation-adjusted … [Read more...]
COMPLIANCE PLANS
OIG Monthly Work Plan Review: October 2018
October 19, 2018
October saw five new OIG Work Plan items. One has direct implications for labs, while two have potential implications for some labs. These three items are detailed below. 1. CMS Medicare Beneficiary … [Read more...]
FEE SCHEDULES
Medicare Reimbursement: Labs Propose Solutions to PAMA Part B Pricing Problem
October 15, 2018
CMS recently issued its annual proposed rule on 2019 Medicare Part B reimbursement. For many labs, the number one concern is the proposed extension of the controversial PAMA "market pricing" scheme to … [Read more...]
FALSE CLAIMS
PAMA: ACLA Loses Court Lab Fees Battle But May Still Win Regulatory War
October 11, 2018
It was a long shot to begin with. But that doesn't ease the disappointment of what happened in a Washington, DC courtroom when a federal judge tossed a lab industry lawsuit challenging the legality of … [Read more...]
CMS
Reimbursement Trends: OIG Report Shows Slight Uptick in 2017 Medicare Part B Lab Payments
October 10, 2018
On Jan. 1, 2018, the new Medicare Part B PAMA Clinical Laboratory Fee Schedule (CLFS) in which lab test reimbursements are based on a single national fee lab schedule for lab tests rather than 57 … [Read more...]
STARK LAW
Stark Relief: Comments Urge Change but Don’t Expect Anything Too Dramatic
October 9, 2018
After decades of resistance, CMS is giving serious indications of its willingness to entertain changes to relieve the "undue regulatory impact and burden" imposed by the Stark Law. Back in June, CMS … [Read more...]
HEALTH CARE REFORM
Health Insurance Market: Two Recent Changes & Their Impact on Labs
October 1, 2018
Amid all the talk of sweeping reform of the health insurance marketplace, the smaller, interim changes get overlooked despite their direct impact on labs and other providers. Two such changes took … [Read more...]
COMPLIANCE CORNER
Stark Relief: Change Seems Imminent but Less Dramatic than Industry Wants
September 27, 2018
CMS is giving serious indications of its willingness to entertain Stark Law relief. Back in June, CMS issued a Request for Information (RFI) seeking public comments and suggestions on changes to … [Read more...]
HEALTH CARE REFORM
Medicare Reimbursement: How CMS Price Transparency Proposal Could Hurt Labs & Patient Relations
September 24, 2018
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...]
