As its days dwindle down, the Trump administration proposed regulatory changes designed to ease prior authorization rules and improve provider and patient access to medical records. Specifically, the … [Read more...]
Utilization Management
CMS Proposes New Regulations to Streamline and Speed Up Payor Prior Authorization
January 4, 2021
REIMBURSEMENT
Labs and Private Payors Clash Over Reimbursement of COVID-19 Testing
November 27, 2020
Things are getting ugly. The unfortunate convergence of resurgent COVID-19 cases, lingering testing supply bottlenecks and Thanksgiving are once more stretching labs to the breaking point and fraying … [Read more...]
CMS Says Improper Medicare Fee-for-Service Payments Are Down $15 Billion Since 2016
November 17, 2020
CMS is claiming that its “aggressive corrective actions” have saved taxpayers over $15 billion in improper Medicare Fee-For-Service (FFS) payments over the past four years. According to the November … [Read more...]
Business Trends
Labs Partner with Airlines to Offer COVID-19 Testing to Travelers
November 17, 2020
civCOVID-19 has greatly complicated air travel from country to country and even state to state. While entrance rules vary from place to place, a number of jurisdictions are allowing travelers to avoid … [Read more...]
Reimbursement
CMS Disguises COVID-19 Rate Cut as Incentive to Process Tests Faster
November 2, 2020
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
October 19, 2020
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...]
Economic Trends
Labs Lost Less & Will Recover More than Other Healthcare Sectors, Says New Report
October 4, 2020
Although it’s not exactly “Happy Days Are Here Again,” a new S&P report is predicting that the healthcare sector has seen the worst of the COVID-19 pandemic and won’t have to go through “a return … [Read more...]
Technology
CMS Proposes Clarified Medicare Coverage “Reasonable and Necessary” Criteria for Breakthrough Devices
September 17, 2020
On Sept. 1, CMS proposed a new rule that would, among other things, shed some light on an issue that has been a perennial compliance and reimbursement stumbling block for developers of new lab tests: … [Read more...]
Fee Schedules
2021 Medicare Physician Fee Schedule Slashes Lab Reimbursements 5% but Provides Some PAMA Relief
September 4, 2020
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
September 3, 2020
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...]
