If your lab bills Medicare for phlebotomy travel allowances, a Medicare Administrative Contractor (MAC) claims audit may be in your future. The threat stems from a new Office of Inspector General … [Read more...]
Compliance Alert
OIG Calls on CMS to Recover Phlebotomy Travel Allowance Overpayments
September 23, 2021
Reimbursement
Biden Pulls Plug on Automatic Medicare Coverage for MCIT “Breakthrough” Devices
September 23, 2021
In a reminder of why politics and presidential elections matter so much, the Biden administration announced that it’s scrapping a Trump regulation that would have automatically provided initial … [Read more...]
Independent Labs
CMS Clarifies IDTF Billing, Coding and Coverage Rules
September 23, 2021
In September, the Centers for Medicare & Medicaid Services (CMS) issued new guidance making some important clarifications on Independent Diagnostic Testing Facility (IDTF) billing requirements. … [Read more...]
Billing and Coding
Medicare to Reimburse 6 New CLIA-Waived Tests, Starting Oct. 1
September 6, 2021
The FDA recently approved a half a dozen assays as CLIA-waived tests that Medicare will reimburse when properly billed and coded by CLIA-certified labs. On Aug. 6, CMS sent out coding instructions to … [Read more...]
Labs in Court
Blue Cross and Blue Shield Sues Lab for COVID-19 Test Price Gouging
August 17, 2021
Case: Blue Cross and Blue Shield of Kansas City is suing GS Labs for COVID-19 test price gouging, contending that the national testing facility inflated its cash prices and performed medically … [Read more...]
REIMBURSEMENT
Labs and Payors Take Their COVID-19 Test Reimbursement Feud to Court
August 5, 2021
The very public feud between health insurers and labs over payment of COVID-19 tests has just entered a new stage: litigation. FFCRA, CARES & the Free Test Mandate On March 18, 2020, at … [Read more...]
REIMBURSEMENT
Labs Sue National Insurers for Not Reimbursing COVID-19 Testing Claims
July 1, 2021
Medical testing lab Genesis Laboratory Management is suing UnitedHealth Group for not paying claims for COVID-19 tests. The lawsuit, filed on June 2 in the U.S District Court for the district of New … [Read more...]
BILLING
OIG Work Plan Targets Medicare Part B Billing & Payment of Lab Tests
June 28, 2021
During the Public Health Emergency (PHE), the Department of Health and Human Services (HHS) has cut labs extraordinary slack in the form of waivers that temporarily loosen Medicare test coverage rules … [Read more...]
PRICE TRANSPARENCY
CMS Proposes to Ease but Not End Hospital Price Transparency
June 28, 2021
If you’re a hospital lab administrator, you’ll probably be happy to learn that the Biden administration is proposing to repeal some of the more troublesome Trump price transparency rules relating. But … [Read more...]
REIMBURSEMENT
Ensure Proper Billing of New FDA-Approved CLIA-Waived Tests
June 28, 2021
Reminder: Effective July 1, labs can bill Medicare for a number of new CLIA-waived tests approved by the FDA. Here are the key details you need to know to ensure maximum reimbursement and proper … [Read more...]
