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
PAMA: OIG Backing of CMS Heats Up Market-Based Lab Rates Controversy
From - G2 Compliance Advisor
CMS did it right and saved Medicare a boatload of money in the process, concludes a new OIG report reviewing the methods CMS used to establish…
Proposed 2019 Medicare PFS: The 5 Things Labs Need to Know
From - G2 Compliance Advisor
On July 12, CMS issued the proposed 2019 Medicare physician fee schedule (PFS), with comments scheduled to end on Sept. 10. Takeaways…
Proposed 2019 Medicare HOPPS Rule: The 4 Things Labs Need to Know
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PAMA Unlocks Golden Age for Innovative Diagnostics
By Chance Scott bio
The publication of the 2018 Clinical Laboratory Fee Schedule (CLFS) in January saw a long and heated debate within the lab community come to fruition…
Getting Paid: Medicare to Cover Next Gen-Sequencing Tests for Advanced Cancer
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CMS to OIG: Get Back the $66.3 Million You Improperly Paid to Labs for Urine Validity Tests
From - G2 Compliance Advisor
As if times were not already tense enough for labs that bill Medicare for urine drug tests, the OIG ratcheted up the pressure another notch on…
Out of Network: 6 Frequently Asked Questions
By Richa Singh bio
As labs face an increasingly challenging reimbursement environment, more providers are doubling down on out-of-network strategies to maximize on collections opportunities…
CAP Files Amicus Brief in Support of ACLA Motion for Summary Judgement in PAMA Lawsuit
From - G2 Compliance Advisor
The College of American Pathologists (CAP) filed an amicus curiae brief in support of a motion by the American Clinical Laboratory Association (ACLA) for summary judgement to…
CMS Ignored Congressional Intent in Implementing New Clinical Lab Payment System Under PAMA, ACLA Charges in Suit
From - G2 Compliance Advisor
The government agency that runs the Medicare program failed to follow a congressional directive to implement a market-based laboratory payment system…