Labs In Court

Pennsylvania Medical Assistants Confess to Participating in Genetic Test Fraud Scheme

  Case: Federal and state enforcers are closing in on a Pennsylvania primary care physician who allegedly ripped off Medicare for genetic tests to the tune of $755,241. At the center of the scheme is … [Read more...]

OIG Findings

OIG Reports that 2018 Medicare Part B Lab Test Spending Increased Despite PAMA Cuts

It wasn’t supposed to happen like this. The expectation was that the new PAMA market-based pricing system was going to save Medicare 10 percent or more on lab test reimbursements. But it hasn’t … [Read more...]

LABS IN COURT

Texas Scammer Gets 20 Years for Role in $50 Million Lab Test Ripoff

Case: The plot unfolded 10 years ago when a then 26-year-old woman and three co-conspirators set up 24 phony diagnostic testing centers in Houston. Offices were rented in 28 locations even though none … [Read more...]

COVERAGE

Medicare Coverage: NGS Testing of Early-Stage Cancer Patients Is Back in Play

The reimbursement outlook for those who provide next generation sequencing (NGS) testing to early-stage cancer of Medicare patients with hereditary risks is far brighter today than it was a few weeks … [Read more...]

PAMA

Medicare Reimbursement: Part B Lab Payments in Final Year before PAMA

Part B payments for lab tests in 2017, the final year under the old reimbursement rules, totaled $7.1 billion, up slightly from the $6.8 billion Medicare paid in 2016 and little changed over the … [Read more...]

BILLING & CODING

Medicare Reimbursement: CMS Begins Implementing New HOPPS Date of Service Rules for ADLTs & Molecular Pathology Tests

CMS has begun implementing the new rules that exempt advanced diagnostic laboratory tests (ADLTs) and molecular pathology tests from Medicare Hospital Outpatient Prospective Payment System (HOPPS) … [Read more...]

PAMA

PAMA Unlocks Golden Age for Innovative Diagnostics

By Chance Scott  bio The publication of the 2018 Clinical Laboratory Fee Schedule (CLFS) in January saw a long and heated debate within the lab community come to fruition. When Congress … [Read more...]

FOCUS ON

Value Care: CMS Value Modifier Programs Ends Not with a Bang but a Whimper

Thanks for nothing. While CMS likes to congratulate itself for using provider pay adjustments to "transform the healthcare delivery system," more often than not, the rhetoric fails to live … [Read more...]

HEALTH CARE REFORM

Medicare Reimbursement: Federal Government Funding Extension Includes a Boatload of Medicare Changes

The government shutdown fiasco is having an impact on Medicare spending and reimbursement. But the crucial details are being buried in the legislative paperwork. So we decided to ferret them out for … [Read more...]

INSIDE THE LAB INDUSTRY

PAMA-geddon: Lab Industry Asks Court to Stop New 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...]


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