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    • November 27, 2017

    Growing numbers of hospitals are being asked to enter into a “hospital outpatient department” billing arrangement involving lab testing. One common attribute of these HOPD schemes is that the organizers want the hospital, as an in-network provider, to bill for all the lab tests performed in the organizers’ labs. The hospital and the HOPD... more

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    • October 25, 2017

    The Pathologists Quality Registry is a qualified clinical data registry (QCDR) launched by the College of American Pathologists (CAP) in 2017. The registry can improve practice performance, through benchmarking against other pathology practices, and make it easier for pathologists to qualify for bonuses under Medicare's Merit-based Incentive... more

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    • September 28, 2017

    The CAP recommended revising the 2018 Medicare Hospital Outpatient Prospective Payment System (HOPPS) proposed rule to ensure that the laboratory date of service (DOS) for all molecular testing is the date of performance rather than the date of collection, to improve the consistency with Medicare payment policy. In the September 11 letter to CMS,... more

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    • September 28, 2017

    A coalition of physician groups, led by the CAP, is urging the National Conference of Insurance Legislators (NCOIL) to make significant changes to its draft Out-of-Network Balance Billing Transparency Act to ensure network adequacy and fair payment for out-of-network services. The National Conference of Insurance Legislators (NCOIL) is an... more

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    • September 28, 2017

    The College of American Pathologists (CAP's) Local Coverage Determination Clarification Act of 2017 bill gained support in both the Senate and also in the House of Representatives this summer by adding additional members of congress who support LCD reform. The CAP continues to work and advocate for its members by helping to improve transparency... more

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    • September 28, 2017

    PMC recognizes the need for a change to CMS' "laboratory date of service policy," which requires hospitals to manage the complex billing processes for many laboratory tests performed within 14 days after a patient's discharge from the hospital even if the test is performed at an outside laboratory. As PMC notes in the letter, the administrative... more

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    • July 28, 2017

    On June 28th, by a vote of 218-210, the House of Representatives passed H.R.1215, the Protecting Access to Care Act of 2017 which adds limitations to medical malpractice cases. The bill was opposed by all Democrats and a handful of Republicans. The expressed goal of the legislation is to improve access to, and the quality of, medical care. The... more

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    • July 28, 2017

    Here’s a groundbreaking way payers are keeping healthcare costs down. Anthem Blue Cross and Blue Shield (BCBS) of Georgia sent letters to its members in May informing them that they will no longer be reimbursed by the insurer for “non-emergency” related services obtained in emergency rooms (ERs). Pathology groups and medical laboratory leaders,... more

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