Navigate Shifting Reimbursement Criteria for Molecular Testing
At TELCOR, we’ve recently identified a notable shift in how molecular claims specifically associated with CPT code 87798, are being processed by...
On Dec. 27, the Centers for Medicare & Medicaid Services (CMS) published updated independent dispute resolution (IDR) entity fees for 2025 on the No Surprises Act webpage.
The IDR entity fee ranges are unchanged from 2024, from $200 to $840 for a single determination and $268 to $1,173 for a batched determination, plus a $115 administrative fee per party per dispute. While some specific entities’ fees remain unchanged from 2024, others have seen increases or decreases for 2025.
A complete list of certified dispute resolution entities can be found on the CMS website.
Source:
https://www.ama-assn.org/health-care-advocacy/advocacy-update/jan-10-2025-national-advocacy-update
https://www.cms.gov/nosurprises/help-resolve-payment-disputes/certified-idre-list
Quality Payment Program Claim Adjustment Applied to Correct Conversion Factor
The Centers for Medicare & Medicaid Services has found a system issue related to the 2026 Medicare Physician Fee Schedule conversion factors.
Updated CDLT Data Reporting Period to Begin May 1
Effective May 1, clinical diagnostic laboratories will be required to follow new data reporting requirements for clinical diagnostic laboratory tests...