The Business of Testing

Hospital Laboratories Take a Stand Against Controversial UnitedHealthcare Outpatient Reimbursement Policy

The cold war between hospital laboratories and the nation’s third largest health insurer, UnitedHealthcare (UHC), over reimbursement of diagnostic tests is getting hotter by the day. At the center of … [Read more...]

Focus On

How the Transition from Trump to Biden Will Affect Federal Regulation and Reimbursement

“Meet the new boss. . . same as the old boss.” The Who’s “Won’t Get Fooled Again” is a rock classic; but as far as U.S. presidents and federal regulation are concerned, the “new boss” is almost … [Read more...]

HHS

Hospital Price Transparency Is Here—But How Will It Be Enforced?

With just three days left in 2020, last-ditch efforts to derail HHS’ controversial new hospital transparency rules before they took effect on Jan. 1 failed when the U.S. Court of Appeals for the … [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...]

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...]

Reimbursement

OIG Medicare Lab Spending Report May Warn of Greater Scrutiny of Genetic and Automated Chemistry Tests

PAMA and market-based rate reductions for lab testing was supposed to save Medicare bundles of money. But according to a new OIG report, Medicare Part B spending on lab spending for 2018, the first … [Read more...]

OIG Watch

Agency to Review First Two Years of PAMA-Based Medicare Reimbursements for Lab Tests

As we pass the midpoint of the third year of the PAMA experiment—if that’s what it is—the OIG announced plans to review what happened in years one and two. One of the new items on the agency’s Work … [Read more...]


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