Special Report

Final Rules Offer Real Stark and Kickback Relief but Largely Exclude Labs

With its time apparently running out, the Trump administration completed one of its pet projects by finalizing the kickback reform rules it proposed in October 2019. Issued on Nov. 20, the new final … [Read more...]

CMS Says Improper Medicare Fee-for-Service Payments Are Down $15 Billion Since 2016

CMS is claiming that its “aggressive corrective actions” have saved taxpayers over $15 billion in improper Medicare Fee-For-Service (FFS) payments over the past four years. According to the November … [Read more...]

Reimbursement

CMS Disguises COVID-19 Rate Cut as Incentive to Process Tests Faster

Few would argue that the current turnaround time for COVID-19 testing is too long. But there are good reasons why it’s taking labs so long to process and report test results, including unprecedented … [Read more...]

Reimbursement

New Medicare 2021 Pay Rule Penalizes Labs for Long COVID-19 Test Turnaround Times

On Oct. 15, CMS announced new Medicare reimbursement policies designed to cut turnaround time and speed up processing of COVID-19 tests. Medicare Reimbursement of COVID-19 Testing When the … [Read more...]

Technology

CMS Proposes Clarified Medicare Coverage “Reasonable and Necessary” Criteria for Breakthrough Devices

On Sept. 1, CMS proposed a new rule that would, among other things, shed some light on an issue that has been a perennial compliance and reimbursement stumbling block for developers of new lab tests: … [Read more...]

PANDEMIC

Hospitals, Labs, LTCs Face Big Fines for Failing to Meet New CMS COVID-19 Test Daily Reporting Rules

Nursing and other long-term care (LTC) facilities have been a hotspot for COVID-19 infection since the public health emergency began. On Aug. 27, CMS issued a new Interim rule requiring LTC facilities … [Read more...]

Stark Law

CMS Proposes to Peel Back Restrictions on Physician Owned Hospital Expansions

From the onset, the Administration has assigned a high priority to loosening Stark Law and Anti-Kickback Statute (AKS) restrictions. And now CMS has floated two new proposals allowing for greater … [Read more...]

Fee Schedules

2021 Medicare Physician Fee Schedule Slashes Lab Reimbursements 5% but Provides Some PAMA Relief

On Aug. 3, CMS released the proposed Medicare Physician Fee Schedule (PFS) rule for 2021. Bottom line on top: The agency is slashing lab reimbursement rates. Here are the four key takeaways for labs. … [Read more...]

Medicare Reimbursement

The 4 Things Labs Need to Know about CMS’ Newly Proposed 2021 OPPS Rule 

On Aug. 4, CMS posted the proposed Outpatient Prospective Payment System (OPPS) Rule for 2021.  In case you don’t feel like reading all 785 pages of the Rule, here’s a high level summary of the four … [Read more...]

New Laws

January 1, 2021 Is D-Day for Hospital Pricing Transparency 

It appears to be full speed ahead for hospital price transparency. The controversial effort to make hospitals divulge information about their healthcare pricing, including lab procedures, is very much … [Read more...]


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