Modifier Decision Trees for Hospice Billing
Knowing when hospice patient services should be covered and which appropriate modifiers, GW or GV, should be used can be confusing. Novitas Solutions created simple decision trees to help [...]
CMS Released a Proposed LCD (DL39063) for Pharmacogenomics Testing
On June 11, the Centers for Medicare & Medicaid Services (CMS) released a proposed Local Coverage Determination (LCD) for Molecular Diagnostic Services Program (MolDX): Pharmacogenomics Testing. The scope of [...]
HHS Dedicating Funds to HRSA
The US Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced it is dedicating $4.8 billion from the American Rescue Plan (ARP) [...]
Reimbursement Policy Update – April 2021: Laboratory Services Policy
The Laboratory Services Policy, Professional will deny multiplex PCR respiratory viral panels of six or more pathogens reported with the following codes 0155U, 0151U, 0202U, 0223U, 0225U, 87632 and [...]
House Passes Bill Extending Moratorium on 2% Medicare Sequester Cuts Through End of 2021
On April 13, 2021, the House of Representatives voted 384-38 to pass a bill that, among other health care provisions, would eliminate the 2% across-the-board cut to all Medicare [...]
New Surprise-Billing Law on the Way
Andis Robeznieks, Senior News Writer, AMA, references the No Surprises Act:"Most importantly, the final version better reflected the principles that guided the AMA's response to unanticipated medical bills. This includes [...]
MedPAC Report on PAMA & CLFS
The Medicate Payment Advisory Commission (MedPAC) gave a presentation confirming that independent laboratories were overrepresented in PAMA's private-payer data relative to CLFS billing volume (slide 9). Additionally, they confirmed [...]
UHC Designated Diagnostic Provider Laboratory Questionnaire Deadline Extended to March 10, 2021
Designated Diagnostic Providers (DDP) are designed to support UHC members in choosing cost-effective and high-value care providers. For a lab to become a DPP and participate in the benefit [...]
Delays in Medicare 2021 Payments (UPDATED 02/04/21)
UPDATE (02/04/21): TELCOR billing service is now seeing Medicare and HRSA paying on 2021 claims. TELCOR has observed a trend with Medicare, where their payments are being held or [...]
CMS Puts Patients Over Paperwork with New Rule Addressing the Prior Authorization Process
CMS finalized a signature accomplishment of the new Office of Burden Reduction & Health Informatics (OBRHI). This final rule builds on the efforts to drive interoperability, empower patients, and reduce [...]