Is My Lab Required to Report PAMA Data?
Originally put into effect in 2017, the Protecting Access to Medicare Act (PAMA) requires many labs to report private payer data for clinical diagnostic lab tests to CMS every three years. The data is used to determine median payments in an effort to bring the... New Novitas Process Set to Impact Pathology and Laboratory Claims
By: Billie Mildenberger, Director of Audit Services Note: Novitas announced this change will not take effect until Sept. 19, 2024. Starting Aug. 18th, 2024, Novitas will implement a process impacting newly effective molecular pathology and Proprietary Lab Analysis... Effectively Navigating Medicare TPE Audits for Clinical Labs
Medicare’s Targeted Probe and Educate (TPE) program is designed to identify and reduce improper payments, enhance compliance, and educate providers on proper billing practices. While TPE audits are intended to be educational rather than punitive, receiving an... How to Navigate MUE Denial Adjustments
By: Billie Mildenberger, Director of Audit Services, Lighthouse Lab Services RCM Case Study – MUE Denial Adjustments: Medically Unlikely Edits (MUEs) are used by Medicare Administrative Contractors (MACs), to reduce the improper payment rate for Part B claims.... 
Lighthouse Acquires MJB Lab Consulting, Expanding Medical Leadership Services