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Blog Posts by Tag: Regulatory

Love Your Labs—Support SALSA

As Lab Week 2023 approaches, it's important to reflect on the ways in which laboratory professionals contribute to patient care and how legislation can impact their work. The Protecting Access to Medicare Act (PAMA) and the Saving Access to Laboratory Services Act (SALSA) have a direct impact on laboratory services. Did you know?In just three years, PAMA has resulted in payment cuts of...

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How Radiologists Can Maximize Their MIPS Scores by Documenting Performance

Under the traditional Merit-Based Incentive Payment System (MIPS), there are four weighted performance categories that contribute to your total MIPS score. For this blog, we’ll be taking a closer look at the Quality Performance category, which has an impact of between 30 – 85% on your total MIPS score, depending on your practice size and patient population. Meeting the requirements of the Quality...

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What The End of The PHE Means for Laboratory Providers

With the announcement from President Biden that his administration plans to end the COVID-19 Public Health Emergency (PHE) on May 11, 2023, many diagnostic providers are wondering how they will be impacted. CMS has published several provider-specific fact sheets about the PHE waivers and flexibilities, including which have been terminated, have been made permanent or will expire at the end of the...

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No Surprises Act: 2023 Changes and Clarifications

Effective January 1, 2022, the No Surprises Act (NSA) established new federal protections against surprise medical bills and balance billing for services received from out-of-network providers.Since January 2022, CMS has published over 50 resources related to the Act, five of which were released as recently as December. In August 2022, CMS issued the final rules, entitled “Requirements Related to...

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Optum’s Laboratory Benefit Manager Program: Focus on CPT 81479

In 2022, Optum launched its new laboratory benefit management (LBM) program to help health plans reduce unnecessary lab testing through automated payment denial. The LBM program leverages Avalon Healthcare Solutions, which has developed evidence-based lab policies with automated software tools, and the MolDX program, which identifies and establishes Medicare coverage and reimbursement for...

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ACLA Launches “Stop Lab Cuts” Campaign Urging Congress to Enact SALSA

The American Clinical Laboratory Association (ACLA) has launched the Stop Lab Cuts advocacy campaign, urging Congress to stop further Clinical Laboratory Fee Schedule (CLFS) cuts under the Protecting Access to Medicare Act (PAMA) through the enactment of the Saving Access to Laboratory Services Act (SALSA).The campaign includes advertising, media outreach, grassroots engagement, stakeholder...

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AUC Penalty Phase Delayed–Why Radiologists Need to Act Now, Not Later

The appropriate use criteria (AUC) program was established under The Protecting Access to Medicare Act (PAMA) of 2014 to ensure providers ordered the most appropriate advanced diagnostic imaging services for Medicare beneficiaries. Under the program, ordering providers will consult an electronic portal called a Clinical Decision Support Mechanism (CDSM) to ensure the established appropriate use...

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No Surprises Act: Examining the Independent Dispute Resolution Process

The Final Rule implementing the No Surprises Act provides new guidance for the payor-provider independent dispute resolution (IDR) process. The Final Rule directs certified IDR entities to consider the qualifying payment amount as well as certain other specific factors when resolving out-of-network rate disputes and requires payors to be more transparent about changes to codes or modifiers that...

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