Tag: local coverage determinations

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.

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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

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Palmetto GBA Announces Molecular Test Registry

CEO SUMMARY: Palmetto GBA, the nation’s largest Medicare Administrative Contractor (MAC), is asking labs in the J1 jurisdiction to submit applications for each molecular test they run. Molecular assays will receive a unique five-digit alpha-numeric identifier (Z-code) that will be entered into the narrative/comment field on claims. A panel of subject matter experts will evaluate

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Palmetto Execs Explain Molecular Test Policies

CEO SUMMARY: To create more transparency in the process clinical labs use to submit claims for genetic tests, molecular diagnostic tests, and for laboratory-developed tests (LDT), the nation’s largest Medicare Administrative Contractor (MAC) has proposed two new local coverage determinations (LCD). CMS has changed Palmetto GBA’s statement of work to include implementing a lab test

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Medicare Carrier Plans to Reject Molecular Claims

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 submitting claims to Palmetto would need to apply to Palmetto for each MDT or LDT it plans

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