HEALTH CARE REFORM

ACA: DOJ Won’t Defend Individual Mandate in Court—But 16+ States Will

One of the DOJ's principal roles is to defend the federal laws in court cases challenging their constitutionality. But the agency has made it known that it will not be doing that in a lawsuit brought … [Read more...]

FEE SCHEDULES

PAMA Reimbursement: CMS Explains How to Get ADLT Status for New Lab 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...]

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...]

INSURERS & PAYORS

Test Ordering & Utilization: Labs Stand to Benefit from Industry Efforts to Minimize Prior Authorization Red Tape

Although not specifically directed at labs, a new collaboration between the American Medical Association and insurance giant Anthem may offer solutions to a perennial thorn in the side of labs: payor … [Read more...]

LEGISLATION

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

ACLA Goes for Jugular in PAMA Challenge Case Case: Attorneys for the American Clinical Laboratory Association asked the federal court for summary judgment in its lawsuit challenging the legality of … [Read more...]

HEALTH CARE REFORM

PAMA-geddon: Lab Industry Goes to Court to Stop 2018 Medicare Fee Schedule

With CMS refusing to back down, the lab industry has escalated the dispute and asked a U.S. District Court to step in and prevent enforcement of the 2018 PAMA-inspired Part B Clinical Lab Fee Schedule … [Read more...]

HEALTH CARE REFORM

Utilization Trends: Teaching Hospitals Consistently Order More Lab Tests

A new study provides solid evidence for a long-held assumption about how hospitals consume lab tests: teaching hospitals utilize tests at a consistently higher rate than nonteaching hospitals. The … [Read more...]

HEALTH CARE REFORM

High-Deductible Plans Tied to Reduced Use of Health Care, Including Diagnostic Testing

People enrolled in high-deductible health plans (HDHPs) cut their use of health services, including laboratory testing, according to a study published in the October issue of Health Affairs. HDHPs … [Read more...]

HEALTH CARE REFORM

High-Deductible Plans Tied to Reduced Use of Health Care, Including Diagnostic Testing

People enrolled in high-deductible health plans (HDHPs) cut their use of health services, including laboratory testing, according to a study published in the October issue of Health Affairs. HDHPs … [Read more...]

HEALTH CARE REFORM

PAMA Implementation: PLA Codes for Advanced Dx Tests Are Off to a Flying Start

PAMA implementation is so sweeping that it requires a shift in not just payment paradigm but also CPT codes. This has served as the impetus for development of a new class of codes known as … [Read more...]


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