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...]

OUTPATIENT PAYMENTS

How to Determine Date of Service for Part B Billing of Outpatient Lab Tests

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...]

OIG OPINION

Is Your Billing Company Putting You At Compliance Risk?

By Sean McSweeney  bio Does your orthopedic billing company charge a percentage of collections for their coding and billing? They might break out separate charges for statements or other … [Read more...]

REIMBURSEMENT

Medicare Reimbursement: CMS Limits NGS Early Cancer Test Coverage but Industry Fires Back

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...]

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

Medicare Reimbursement: ACLA Court Appeal Maintains 2-Front War for PAMA Relief

It's official. The ACLA is appealing the September federal court decision to dismiss its PAMA lawsuit (ACLA v. Azar). Here's a quick rundown of the three things you need to know. 1. The Legal … [Read more...]

FEE SCHEDULES

Reimbursement Trends: Part B Medicare Lab Payments Up Slightly in 2017

According to a new OIG report, Clinical Laboratory Fee Schedule payments for lab tests in 2017, the last year under the pre-PAMA payment system, totaled $7.1 billion, up slightly from the $6.8 billion … [Read more...]

REIMBURSEMENT

Labs Need to Prepare for Upcoming PAMA Data Collection Period

The impact of PAMA (the Protecting Access to Medicare Act) is already being felt in the laboratory industry. The estimates are bleak. Three-fourths of codes on the Clinical Lab Fee Schedule are now … [Read more...]

FEE SCHEDULES

Medicare Reimbursement: Labs Propose Solutions to PAMA Part B Pricing Problem

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

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...]


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