PAYER CONTRACTS

Three key items to negotiate for successful payer contracts

By Steve Selbst  bio The purpose of this article is to help you, as a provider, to focus on three key items to look for in payer contracts that will help you to get profitable contracts in … [Read more...]

WORKING WITH PAYERS

Billing & Coding: Pathology Group Asks CMS to Raise Medicare Prices for BRCA1/2 Sequencing Tests

The Association for Molecular Pathology (AMP) thinks the final 2019 Clinical Laboratory Fee Schedule payment amounts shortchanges labs that provide BRCA genetic testing and is calling on CMS to … [Read more...]

PAMA

Proposed 2019 Medicare PFS: The 5 Things Labs Need to Know

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 RatesĀ  CMS is proposing a 0.25% increase … [Read more...]

CO-ORDINATING DATA

Laboratory Information Systems (LIS): What You Need To Know To Get Paid

By Sean McSweeney  bio Today, laboratory billing claims require more and more data to successfully get paid. One of the biggest reasons your claims may be getting denied is because you're … [Read more...]

FEE SCHEDULES

How PAMA’s Effect in 2018 Molecular Diagnostic Reimbursement Will Make Labs More Money

By Sean McSweeney  bio The year 2018 is slated to be much brighter for molecular diagnostic labs as PAMA fee schedules show a higher payment rate and amount for many cancer genomics and … [Read more...]

FALSE CLAIMS

Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry

Ohio Hospital System Settles Kickback Claims for $14.25 Million Case: Rather than risk a trial, Mercy Health will pay $14.25 million to settle charges of entering into improper financial … [Read more...]

COMPLIANCE PERSPECTIVES

PAMA Reimbursement: CMS Tells Labs How to Secure ADLT Status for New Tests

Although the 2018 market-based Clinical Laboratory Fee Schedule (CLFS) is officially in effect, implementation of the new PAMA Part B payment rules for lab tests remains a work in progress. On March … [Read more...]

BILLING & COLLECTIONS

Getting Paid: Medicare to Cover Next Gen-Sequencing Tests for Advanced Cancer

In the PAMA era, there are two salient trends in Medicare Part B lab reimbursements: Sharply lower prices for traditional tests; and Wider coverage of newly emerging tests, including some that … [Read more...]

NEWS AT A GLANCE

Case of the Month: $11.4 Million Natera Settlement Shows Genetic Billing & Coding Remains a False Claims Hot Button

Before the opioid crackdown, false billing of genetic tests was the hottest thing in federal fraud enforcement against clinical labs. But while drug testing related to prescription opioids has stolen … [Read more...]

NEWS AT A GLANCE

Case of the Month: Feds Turn Up the Heat on False Billing of Nuclear Stress Tests

While the feds have made urine drug testing of opioid drug patients their number one target for lab-related False Claims Act (FCA) charges this year, nuclear stress tests (NSTs) ordered by … [Read more...]


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