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Revisiting the ‘Substantially in Excess Rule’

BY NOW, NEARLY EVERY LAB MANAGER knows that Medicare lab test fee cuts will commence in just 13 months, on Jan. 1, 2018. The federal Centers for Medicare & Medicaid Services estimates that the f…

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Widespread payer errors will cause headaches as Protecting Access to Medicare Act of 2014 price reporting comes due

This is an excerpt from a 2,700-word article in the November 28 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group. …

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OIG Comments on PAMA Plan and Exclusion of Many Labs from Reporting

ON THE SUBJECT OF LAB TEST MARKET PRICE REPORTING as required under PAMA, many clinical laboratory executives, pathologists, and industry experts see deep flaws in the process the federal Centers for Medicare & Medicaid Services has established. Yet, CMS itself seems blind to the…

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Expert Explains Why Payer Errors Skew Labs’ PAMA Price Data

CEO SUMMARY: In its work with more than 200 lab clients, XIFIN, Inc., of San Diego, sees the best and worst of problems in how labs submit claims to lab tests and how payers process these claims. In this exclusive interview, Lâle White, XIFIN’s Founder and CEO, identifies the systemic …

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Should Labs File Court Challenge To PAMA Price Report Rule?

CEO SUMMARY: Just four weeks remain before CMS begins collecting private payer clinical laboratory test price data. Many lab industry executives have charged that Medicare officials are not following the language of the PAMA statute or the intent of Congress. At stake are $5.4 billion in …

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Why Small Labs and Even Hospitals Are at Risk from PAMA Cuts

CEO SUMMARY: Clinical lab executives and experts who have studied the final rule for PAMA lab test market price reporting are seriously concerned that the design of this rule may put many of the nation’s smallest, but still essential, clinical labs at great risk of financial distress, i…

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Could Community Labs Become Extinct after PAMA?

IN THE PURSUIT OF IMMEDIATE COST SAVINGS, our federal government may be about to tinker with an essential clinical service in ways that will severely harm patients in rural areas and small towns throughout the United States. Specifically, will the final rule to implement PAMA lab test market price r…

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Test price data shows major difference between Medicare lab fee schedule and private payers

This is an excerpt from a 1,500-word article in the November 7 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group. CEO SUMMARY: THE DA…

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Market Price Data Sample from: Hospital Labs with NPI Numbers

Here is the market price data for hospital labs with NPI numbers from XIFIN Inc. Lâle White, Founder and CEO of XIFIN, discusses the data with THE DARK REPORT. EDITOR: The analysis XIFIN has done of hospital …

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Medicare Part B Lab Test Prices Versus Budgeted Payment

THERE IS AN IMPORTANT QUESTION THAT lab industry magazines and news sources have failed to address: How many years are left before Medicare officials drop fee-for-service payment for clinical lab testing? On January 26, 2015, the Department of Health and Human Services (HHS) issued a press rele…

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