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CMS Targeting Errors on Drug Testing Claims Following TPE Review

CMS Targeting Errors on Drug Testing Claims Following TPE Review

by Alex Mitchell | Jan 17, 2024 | Payer Audits & Alerts, CMS Fee Schedules, Billing & CPT Codes, Revenue Cycle Management, Industry Insights

Last year, we notified drug testing providers CMS was reviewing definitive and presumptive drug screening claims for errors and missing documentation as part of its Targeted Probe and Educate (TPE) program. Results for the WPS Region were published last week, showing...
PAMA laboratory reimbursement cuts delayed through 2024

PAMA laboratory reimbursement cuts delayed through 2024

by Alex Mitchell | Nov 27, 2023 | Payer Audits & Alerts, CMS Fee Schedules, Revenue Cycle Management, Industry Insights

PAMA Reporting Delayed Again as Permanent Fix Sought Labs received a welcome reprieve from looming Clinical Lab Fee Schedule (CLFS) cuts this month when Protecting Access to Medicare Act (PAMA) reporting and associated test reimbursement reductions were delayed until...
CMS to Withdraw NCCI Edit Impacting Drug Testing

CMS to Withdraw NCCI Edit Impacting Drug Testing

by Alex Mitchell | Sep 11, 2023 | Billing & CPT Codes, Payer Audits & Alerts, CMS Fee Schedules, Revenue Cycle Management, Industry Insights

CMS is withdrawing NCCI PTP edits between Column One codes 80305, 80306, and 80307 for presumptive test(s), and Column Two codes G0480 – G0483, and G0659 for definitive test(s), according to an announcement posted on the agency’s website and communications from...
Solutions for Sustaining Clinical Pathology Revenue Amidst Challenges

Solutions for Sustaining Clinical Pathology Revenue Amidst Challenges

by lighthouselab | Aug 14, 2023 | CMS Fee Schedules, Pathology Management, Revenue Cycle Management, Industry Insights

For hospital-based pathology groups, mastering the complex revenue cycle management processes surrounding the capture and billing of Professional Component of Clinical Laboratory (PCCP) services is paramount when the group is not being otherwise compensated through...
Cuts for Labs, Pathology again proposed for 2024 Medicare Fee Schedule

Cuts for Labs, Pathology again proposed for 2024 Medicare Fee Schedule

by Alex Mitchell | Jul 17, 2023 | CMS Fee Schedules, Revenue Cycle Management

The 2024 Medicare Physician Fee Schedule Proposed Rule released July 13 is already generating pushback from lab and pathology advocates, such at the College of American Pathologists (CAP), who contend these services and the physicians who provide them cannot sustain...
Reintroduction of SALSA Aims to Fix Lab PAMA Reporting

Reintroduction of SALSA Aims to Fix Lab PAMA Reporting

by Alex Mitchell | Apr 13, 2023 | Clinical Laboratory, CMS Fee Schedules, Revenue Cycle Management, Industry Insights

Independent laboratories have been pushed to the brink of financial instability in recent years due to the price cuts mandated by the Protecting Access to Medicare Act of 2014 (PAMA). However, as part of a yearslong effort to rectify the problematic pricing and...
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