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acla
CMS, Lab Groups Begin Talks About Issues with NCCI Edits
By Joseph Burns | From the Volume XXVI No. 7 – May 20, 2019 Issue
SERIOUS PROBLEMS WITH THE NEW GUIDELINES for the National Correct Coding Initiative (NCCI) that were implemented on Jan. 1 have caused nine clinical laboratory associations and groups to come together and voice their concerns to the federal Centers for Medicare and Medicaid Services…
ACLA: NCCI Guidelines Are a ‘Step Backwards’
By Joseph Burns | From the Volume XXVI No. 6 – April 29, 2019 Issue
CEO SUMMARY: In a letter to the National Correct Coding Initiative, the American Clinical Laboratory Association (ACLA) raised significant concerns about new language in the policy manuals for Medicare and Medicaid. ACLA said the new NCCI guidelines for molecular and other tests requiring…
Labs Get High Denial Rates Under New NCCI Rules
By Joseph Burns | From the Volume XXVI No. 6 – April 29, 2019 Issue
CEO SUMMARY: Under guidelines the National Correct Coding Initiative issued last year, many clinical laboratories are not getting paid for some tests. The rates of denial for labs running mostly molecular tests could range from 40% to 100% of revenue, one billing expert said. Implemented …
COLA: GAO Should Address PAMA’s Effect on Patients
By Joseph Burns | From the Volume XXVI No. 4 – March 18, 2019 Issue
CEO SUMMARY: In a recent statement, COLA, an organization that accredits clinical labs, expressed strong concern about how a report from the Government Accountability Office did not address how the Protecting Access to Medicare Act of 2014 (PAMA) affects patients’ access to testing, esp…
In PAMA Appeal, ACLA Says Federal District Court Erred
By Joseph Burns | From the Volume XXVI No. 1 – January 14, 2019 Issue
LAST MONTH the American Clinical Laboratory Association (ACLA) filed an appeal in its case against the federal Department of Health and Human Services (HHS). In its court filing, the ACLA said that a federal district court judge erred in her ruling against the lab as…
Several Big Surprises in 2018’s Top 10 Lab Stories
By Robert Michel | From the Volume XXV No. 18 – December 24, 2018 Issue
CEO SUMMARY: This year’s list of the Top 10 Lab Industry Stories for 2018 is dominated by new directives from Medicare and private health insurers, as well as significant decisions by federal courts. Collectively, these developments create new compliance risks for all clinical laborator…
New Opioid Law Goes Beyond – Far Beyond – Anti-Kickback Statute
By Mary Van Doren | From the Volume XXV No. 17 – December 3, 2018 Issue
CEO SUMMARY: At the last minute, Congress added all clinical laboratories to a far-reaching provision in the newly-enacted …
Attorney Explains Risks from New ‘Support Act’
By Joseph Burns | From the Volume XXV No. 17 – December 3, 2018 Issue
CEO SUMMARY: Legislation signed into law on Oct. 24 was designed to stem the nation’s opioid crisis. But in addition to applying to sober homes and addiction treatment centers, the law also applies to clinical laboratories. Called the ‘Support for Patients and Communities Act,’ the …
New Opioid Law Hits Labs Paying Sales Commissions
By Joseph Burns | From the Volume XXV No. 17 – December 3, 2018 Issue
CEO SUMMARY: At the last minute, Congress added all clinical laboratories to a far-reaching anti-kickback provision in the newly-enacted Support for Patients and Communities Act. This provision applies to all payers, both government and private. Lab experts say this new law could have a n…
CMS Adjustments for Medicare Fee Schedule Might Be Too Late
By Mary Van Doren | From the Volume XXV No. 16 – November 13, 2018 Issue
This is a summary of two articles in the Nov. 13, 2018 issue of THE DARK REPORT. The complete articles are available only to paid members of the Dark Intelligence Group. CEO SUMMARY: On Nov. 2, the federal Centers for Medicare and Medicaid Services released its Physician Fee S…
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