Tag: local coverage determination

Medicare Ends Coverage for Some Pharmacogenomic Testing

pharmacogenomic testing image test tube

CEO SUMMARY: Medicare’s decision to cease covering many pharmacogenomic tests puts as many as 19 million Americans who have genetic variations affecting their response to medications at risk. These medications are commonly prescribed for patients with cardiovascular disease, pain, depression, anxiety, and cancer. Meanwhile, medical centers such as Mayo Clinic are conducting clinical studies to collect evidence that appropriate use of pharmacogenomic tests can improve patient outcomes while also reducing the cost of care.

View Article

Medicare Ends Coverage for Genetic Drug-Sensitivity Tests

pharmacogenomic testing image test tube

CEO SUMMARY: Medicare’s decision to cease covering many pharmacogenomic tests puts as many as 19 million Americans who have genetic variations affecting their response to medications at risk. These medications are commonly prescribed for patients with cardiovascular disease, pain, depression, anxiety, and cancer. Meanwhile, medical centers such as Mayo Clinic are conducting clinical studies to collect evidence that appropriate use of pharmacogenomic tests can improve patient outcomes while also reducing the cost of care.

View Article

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 on lab pricing data produced as a result of whistleblower lawsuits against labs that were settled in 2011. Should prices fall below the costs of performing these tests, the Medi-Cal program may see legal challenges from the lab industry.

View Article

What Labs Need to Do as Payers Audit More Claims

CEO SUMMARY: Attorneys who advise pathologists and clinical laboratories on compliance issues say the number of audits from the government and third-party payers has increased sharply in recent years. In those audits, payers are looking for recoupment of overpayments. A lab’s failure to provide proper documentation during these audits can result in the need to pay sixand seven-figure amounts. Payers also are auditing out-of-network billing and patient balance billing.

View Article

April 28, 2014 Intelligence: Late Breaking Lab News”

In recent years, a series of decisions involving molecular diagnostics tests made by Medicare officials and the Medicare Administrative Contractors (MACs) have caused much disruption in the clinical laboratory industry. In response to these developments, on April 16, the California Clinical Laboratory Association (CCLA) and a Medicare beneficiary filed a lawsuit against the U.S. Department

View Article