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2021 Medicare Fee Schedule boost: See impact to pathology services

2021 Medicare Fee Schedule boost: See impact to pathology services

by Alex Mitchell | Jan 13, 2021 | Pathology Management, Billing & CPT Codes, CMS Fee Schedules

As part of the COVID relief and appropriations package signed into effect Dec. 27, Congress took steps to mitigate significant fee schedule reductions for several specialties that were designed to offset payment boosts for evaluation and management (E/M) services....
New Stark Law rules create safe harbors to promote value-based care, telehealth

New Stark Law rules create safe harbors to promote value-based care, telehealth

by Alex Mitchell | Nov 30, 2020 | Revenue Cycle Management, Pathology Management

A pair of Final Rules issued recently by CMS and the OIG establishes new safe harbors aimed to promote value-based care, while also modifying some of the existing safe harbors. CMS said the intent behind the new rules, which were first proposed in 2019, is to allow...

Key Industry Terms in Laboratory Billing

by Alex Mitchell | Nov 28, 2020 | Revenue Cycle Management, Pathology Management

ACO Accountable Care Organization: A model for patient population management APC Ambulatory Patient Classifications: The government’s method for paying for outpatient services for the Medicare program. APM Alternative Payment Model: These are the new payment models...
CMS clarifies rules for U0005 COVID add-on payment

CMS clarifies rules for U0005 COVID add-on payment

by Alex Mitchell | Nov 10, 2020 | Denial Management, Revenue Cycle Management, Pathology Management, Billing & CPT Codes

When CMS announced its intent to reduce payments for high-throughput COVID-19 tests next year while offering providers a path to be made whole if they met new turnaround time targets, several questions arose concerning how the agency intended to monitor its new...
MolDX removes coverage for BioFire, GenMark respiratory panels

MolDX removes coverage for BioFire, GenMark respiratory panels

by Alex Mitchell | Oct 7, 2020 | Revenue Cycle Management, Pathology Management, Billing & CPT Codes

As of Oct. 1, MOLDX has updated their LCDs/Billing and Coding Articles for the Multiplex Nucleic Amplified Tests for Respiratory Panels to no longer cover the PLA codes 0098-0099U, U100U, and 0115U. These PLA codes represent respiratory panels using BioFire® or...
LCD causing issues surrounding reimbursement for respiratory viral panels during PHE

LCD causing issues surrounding reimbursement for respiratory viral panels during PHE

by Alex Mitchell | Sep 17, 2020 | Pathology Management, Revenue Cycle Management

LCD Alert: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels During the COVID-19 PHE (Noridian and Palmetto) Issue: Covered under limited circumstances Introduction and Disclosure: Lighthouse RCM Solutions is a revenue enhancement and laboratory...
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