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Coming Next Year for Labs: PAMA, FDA, LDTs, and More

CEO SUMMARY: As 2016 approaches, nearly every lab organization is watching and waiting to learn how federal regulators at CMS and the FDA will move forward with plans to implement PAMA market reporting and regulation of laboratory-developed tests, respectively. Most knowledgeable observer…

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Letter to Florida Doctor Offers to Waive Lab Test Fees

CEO SUMMARY: Florida’s highly-competitive market for lab testing services is again seeing some lab companies use “Waiver of Charges to Managed Care Patients” agreements with physicians in situations where the lab is an out-of-network provider. This means the lab will do free testing…

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Labs React with Criticism to Proposed ADLT Rule

CEO SUMMARY: Some in the lab industry had high hopes that passage of the Protecting Access to Medicare Act (PAMA) last year would favorably resolve a number of important issues. However, those hopes were dashed following the September 25 release by CMS of a proposed rule setting out how i…

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Labs Have Questions for CMS on Proposed Rule

CEO SUMMARY: On September 25, CMS took a long overdue step to issue a proposed rule on how medical laboratories are to report private market prices for lab tests to the Medicare program during 2016. The proposed rule provides insights as to how CMS envisions pricing new tests and advanced…

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CMS Releases Draft of PAMA Market Price Rule

CEO SUMMARY: CMS’ proposed rule details how it will collect private market data, then use that data to establish prices for the Medicare Part B Clinical Laboratory Fee Schedule beginning in 2017. The proposed rule will limit data reporting to les…

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Are Clinical Labs and MACs Ready to Implement ICD-10?

ARE CLINICAL LABORATORIES and pathology groups prepared for ICD-10? Or, perhaps a better question to ask is this: Are Medicare administrative contractors prepared to switch to ICD-10 on October 1? A recent survey of clinical laboratories and pathology groups by McKesson Corporation showed th…

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Medi-Cal to Cut Lab Pay on July 1 by 25% to 30%

CEO SUMMARY: Since 2011, state officials in California have aggressively cut laboratory testing fees for Medi-Cal, the state’s Medicaid program. Now state officials say they will implement a new methodology next month for determining lab testing fees. The new methodology is based…

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Deep-Discount Lab Prices to Haunt All California Labs

FOR MORE THAN 20 YEARS, THE CLINICAL LAB INDUSTRY been marked by a fundamental schism. On one side of the schism are the public lab companies that have aggressively used deeply-discounted loss-leader pricing practices when negotiating managed care contracts to capture market share. On the other si…

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New MoPath Lab Coalition Takes its Case to Congress

CEO SUMMARY: Prices recently established for molecular diagnostic tests are so low that they put patient access in jeopardy, declared a new lab industry coalition in a statement delivered to members of Congress. Called the Coalition to Strengthen the Future of Molecular Diagnosti…

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Beware Ides of March! Lawmakers Are in Session

CEO SUMMARY: Few pathologists and lab administrators know that, when the Protecting Access to Medicare Act of 2014 (PAMA) became law last April 1, language in the bill was scored to reduce Part B clinical laboratory test fees by $2.5 billion over 10 years. Congress used those lab…

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