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ACLA Wins in Appeals Court Versus HHS

Recently, the DC Court of Appeals determined that federal courts do in fact “have jurisdiction to decide the merits of a challenge to the federal government’s administration of the Protecting Access to Medicare Act (PAMA).”1 This ruling will result in the ACLA vs. Azar case being sent back to the DC District Court to determine if the decision from HHS/CMS to exclude hospital outreach labs from...

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ACLA Issued a Statement to CMS on Automated Chemistry Test Panels

After claims from the Government Accountability Office (GAO) in November of 2018 that labs unbundling automated chemistry test claims will correlate to a drastic increase in Medicare spending, many industry thought leaders are responding. Most recently, ACLA has released a statement claiming that GAO’s assumptions are not backed by Medicare’s public claims data, or by ACLA’s own survey conducted...

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The 5 Keys to Minimizing the Impact of PAMA

At this year's Executive War College Conference, XIFIN CEO and Executive Chairman, Lâle White presented on PAMA’s effects on laboratories and gave some thought-provoking ideas on how labs can respond. This blog post will cover many of the topics that Lâle discussed, starting with this timeline of industry events which provides background on the laboratory reimbursement environment...

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How the Most Successful Laboratories in the Country Continue to Thrive in the Midst of an Increasingly Complex Reimbursement Environment

The business of laboratory revenue cycle management (RCM) becomes more complex every day; with reductions in reimbursement, increasing rejections and denials, payor specific billing rules, shifting financial reporting and accounting requirements (PAMA, FASB ASC 606, medical economics reporting), OIG and EKRA (false claims) compliance standards, malware and ransomware attacks, etc. Once there was...

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Final Steps in Preparing for the PAMA Reporting Period (Part 2)

In our last post of this series, we identified “The First Steps in Preparing for the PAMA Reporting Period” as confirming your laboratory’s applicable lab status, executing an RCM data review, and assigning a project team and project team lead. Once you have carried out these steps, there are four additional steps to be taken before you complete your submission.  Step 4:...

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PAMA Data Collection & Reporting – Why EHR Revenue Cycle Modules Aren’t Enough for Hospital Labs (Part 1)

Hospital and health system laboratories are under many of the same pressures as independent clinical laboratories. Compliance obligations and continued fee compression place a tremendous economic burden on many labs. While in the past, some hospital and health system leaders overlooked the economic value of the outreach lab, these leaders now recognize that outreach labs can add both strategic...

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New Study Demonstrates GAO’s PAMA Report Based on Faulty Assumptions

In a XIFIN blog post from April 5, we address that the Government Accountability Office (GAO) report entitled, “Medicare Laboratory Tests Implementation of New Rates May Lead to Billions in Excess Payments” appears to demonstrate a misunderstanding of how price and panel bundling work in laboratory billing and reimbursement.The report appears to suggest that American Medical Association (AMA)...

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The First Steps in Preparing for the PAMA Reporting Period (Part 1)

Solid reporting from all applicable laboratories is the key to mitigate future PAMA fee schedule cuts. This means labs need to be able to report on actual allowables vs. payments, validate the accuracy of payments, and optimize appeals activity to avoid under-reporting payments. All applicable labs are included in the current data collection period now underway for the first half of 2019.Step 1:...

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