Utilization Management

CMS Proposes New Regulations to Streamline and Speed Up Payor Prior Authorization

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...]

REIMBURSEMENT

Labs and Private Payors Clash Over Reimbursement of COVID-19 Testing

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

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

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

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

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

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

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

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 

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...]


(-00000g2)