FOCUS ON

Medicare Reimbursement: New Guidance on Date of Service Rules for Part B Billing of Hospital Outpatient Lab Tests

In 2018, new date-of-service rules took effect for billing and coding of outpatient lab tests under Medicare Part B, rather than as part of the Hospital Outpatient Prospective Payment System (HOPPS) … [Read more...]

COURT CASES

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

Texas Pathology Lab Settles EHR Consulting Kickback Claims for $63.5 Million Case: In 2006, HHS implemented an AKS safe harbor and Stark exception letting non-physician providers pay up to 85% … [Read more...]

EMERGING TESTS

Study Showing PGx Testing Improves Depression Outcomes, Key to Myriad’s Reimbursement Strategy

Pharmacogenomic testing (PGx) provides clinically meaningful improvement in response and remission rates for difficult-to-treat depression patients over standard of care, according to a study … [Read more...]

REIMBURSEMENT

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

Tennessee Pain Doctor Faces Jail for Opioid Abuses, Medicare Fraud Case: The doctor is facing 45 charges, including 22 counts of illegal distribution of a controlled substance for routinely … [Read more...]

THE BUSINESS OF TESTING

Payer Medical Policies Can Promote Effective Use of Comprehensive Sequencing In Community Oncology Setting

Comprehensive genomic profiling (CGP) identifies clinically relevant genomic alterations that can be used to inform treatment decisions in community-based oncology practices that benefit both patients … [Read more...]

PAMA

Medicare Reimbursement: CMS Provides Needed PAMA Relief—But Newly Covered Hospital Labs Must Report in 2019

The battle between CMS and the lab industry over Medicare Part B pricing for lab tests could be on the road to resolution notwithstanding the ACLA's recent court loss. But even as the legal battle … [Read more...]

COURT CASES

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

Wisconsin Health System Settles Stark Claims for $12 Million Case: In a case that began as a whistleblower suit, a company affiliated with Advocate Aurora Health, Inc. has agreed to pay $12 … [Read more...]

CONSUMER FRAUD

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

Molecular Lab Vigorously Denies But Pays $1.8 Million to Settle Fraud Charges Case: The feds claim that Molecular Testing Labs, a toxicology and genetics lab in Washington State, paid local labs … [Read more...]

HEALTH CARE REFORM

Compliance Perspectives: PAMA Pitfalls & Survival Strategies

PAMA's deep Medicare reimbursement cuts have had a devastating impact on the lab industry. Recent CMS changes in the 2019 Final Rule should provide a degree of pricing relief but not until 2021. In … [Read more...]

FOCUS ON

Medicare Reimbursement: CMS Provides Needed PAMA Relief—But Newly Covered Hospital Labs Must Report in 2019

The battle between CMS and the lab industry over Medicare Part B pricing for lab tests could be on the road to resolution notwithstanding the ACLA's recent court loss. But even as the legal battle … [Read more...]


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