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clinical lab fee schedule
CMS Update Plans for Medicare Clinical Lab Fee Schedule Could Be in Trouble
By Mary Van Doren | From the Volume XXIII No. 5 – April 11, 2016 Issue
This is an excerpt from a 1,400-word article in the April 11 issue of THE DARK REPORT. Full details of the California program are included in the original article, available to paid members. CEO SUMMARY: Evidence from California shows that national la…
New ADLT Payment Rate May Force Lab to Close
By Joseph Burns | From the Volume XXII No. 15 – October 26, 2015 Issue
CEO SUMMARY: Four Medicare Administrative Contractors currently pay $2,821 for CareDx’s AlloMap test. But under the proposal that CMS issued last month to overhaul the clinical lab fee schedule, CareDx would get only $644. Such a steep price cut would put the lab out of business because…
Protecting Access to Medicare Act of 2014 Could Harm Independent Community Labs
By Mary Van Doren | From the Volume XXII No. 3 – February 17, 2015 Issue
In the Protecting Access to Medicare Act of 2014 (PAMA), the Center for Medicare and Medicaid Services (CMA) is directed to collect market price data and use the data to establish prices for the Medicare Part B Clinical Laborato…
ACLA, CAP Comment on Final 2014 Medicare Rules
By Joseph Burns | From the Volume XX, No. 16 – December 2, 2013 Issue
CEO SUMMARY: On November 27, as the nation prepared for the Thanksgiving holiday, the federal Centers for Medicare & Medicaid Services (CMS) announced the long-awaited final rules for 2014. Early analysis of the 1,300 pages of rules CMS released indicates that the agency moderated one…
Medicare Taken to Task about Molecular Test Pricing Method
By Robert Michel | From the Volume XX No. 5 – April 15, 2013 Issue
EDITOR’S NOTE: Submitted by Lâle White, CEO of XIFIN, Inc., of Carlsbad, California, this letter describes the problems caused by the Medicare program’s failure, as of January 1, 2013, to be ready to process and reimburse lab test claims for more than 100 new mo…
One Lab’s Revenue Loss Due to CMS’ Slow Process
By Joseph Burns | From the Volume XX No. 5 – April 15, 2013 Issue
CEO SUMMARY: How is it that some commercial payers for one lab running molecular tests have continued to pay the lab for tests it has run this year, but contractors for CMS have so far failed to pay? That’s the question one lab CEO is asking. Both the commercial payers and the CMS contr…
Low 2013 Molecular Rates May Bankrupt Some Labs
By R. Lewis Dark | From the Volume XX No. 2 February 11, 2013 Issue
CEO SUMMARY: Many of the recently issued reimbursement rates for molecular diagnostic tests are inadequate and in fact are lower than the cost of running the tests, lab experts say. Smaller laboratories that specialize in developing and selling molecular tests could be forced to close. As…
Price Cuts, Long Delays in Payment Are Expected
By Joseph Burns | From the Volume XIX No. 18 – December 31, 2012 Issue
CEO SUMMARY: In addition to a steep cut in the 88305 CPT code, anatomic pathology laboratories can expect cuts in the payment from Medicare for molecular and prostate biopsy testing. Two national experts in lab billing and reimbursement warn labs to expect confusion in how both public and…
Competitive Bidding: Once Again, It’s Back!
By Robert Michel | From the Volume XIX No. 13 – September 17, 2012 Issue
CEO SUMMARY: For the clinical lab industry, the concept of competitive bidding for Medicare Part B Clinical Lab Testing may be like the movie “Groundhog Day.” The hero, Bill Murray, kept reliving the same day over and over. So it seems to be with competitive bidding. In the latest rep…
Medicare Carrier Plans to Reject Molecular Claims
By Robert Michel | From the Volume XVIII No. 15 – November 7, 2011 Issue
CEO SUMMARY: In September, Palmetto, a Medicare carrier serving California and seven other states, made public two draft local coverage determinations (LCDs) that revamp its coverage guidelines for molecular diagnostic tests (MDT) and laboratory-developed tests (LDT). All labs su…
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