2024 Laboratory Reimbursement Trends and What to Expect in 2025
Revenue cycle management experts weigh in on the biggest developments of 2024 and how labs can best prepare for 2025 and beyond
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Articles and Reports
Using AI to Improve Reimbursement and Decrease Claim Denials
Though payers’ adoption of AI has made reimbursement more challenging for labs, providers can also use AI to address these issues
Private Payer Reimbursement for Genetic Testing Hinges on Clinical Utility
Two revenue cycle management experts offer tips for clinical labs to improve coverage decisions for genetic tests
Billing & Coding: MAAA Coding 101
What labs and billing managers need to know about multianalyte assays with algorithmic analyses coding for tests based on molecular platforms.
How to Use and Report ICD Codes
An overview and general briefing on some of the most common ICD codes concerns for labs.
CMS Sheds New Light on Proper Use of Modifier 59
Due to the common misuse of this modifier, the Centers for Medicare & Medicaid Services recently issued important new guidance on its proper use.
Getting Paid: How to Complete the ABN Form
Completing the Advance Beneficiary Notice of Noncoverage form can be extremely complex; this guide helps simplify the process.
How Labs Can Avoid Problems When It Comes to Standing Orders
New CMS guidance includes information on how labs can avoid Medicare claims denials and documentation violations related to standing orders.
Federal Court Calls PAMA Rule “Arbitrary,” but Refuses to Strike It Down
D.C. Circuit Court of Appeals agrees with lab industry that CMS got Medicare lab pricing all wrong, but says it’s unable to intervene.
When & How to Use Changed Clinical Laboratory Consult Codes
Use of these codes has frequently raised concerns for compliance due to a lack of clarity regarding when they’re appropriate.
The 14-Day Rule & Billing Medicare for Tests on Stored Specimens
While this reimbursement rule has been in effect since 2018, it can still be quite confusing; this article provides a guide to the basics.
Billing & Coding of Outside Pathology Consultations
A briefing of the current requirements you can use to avoid billing and coding errors at your own lab or pathology practice.
Genomic Tests for Prostate Cancer Risk Stratification Are Now Covered
A newly finalized local coverage determination from MAC Palmetto GBA sets out coverage criteria for two applications of these tests.
