Blog Posts by Date: Nov 2011

4 Reasons Molecular Dx Labs May Not Benefit From New CED Program

  • November 29, 2011

by Lâle White R&D Costs, Lower Fee Schedules Create Catch-22 For Diagnostic Labs In a recent article, a CMS official stated that the revamped CED program could benefit Molecular Dx reimbursement.Unlike other Medicare services currently subject to CEDs, diagnostic services lack the pricing flexibility to recoup research and development costs...


3 Red Flags Behind the 5010 Enforcement Delay. More than a Format Change; Guidance Required on Comments and Edits

  • November 17, 2011

by Lâle White It is not surprising that CMS had to delay enforcement of 5010 compliance in light of the fact that even the small payor community, including a number of MACs and Medicaids, were unable to test and implement 5010 files in production timely; let alone the thousands of providers primarily relying on unprepared clearinghouses and...


3 Ways Palmetto's MolDx Program May Jeopardize Labs

  • November 15, 2011

The Palmetto MolDx program works in conjunction with the two LCDs introduced at the October 19th CAC meeting. The primary LCD that is required for this program to operate as envisioned by Palmetto, is the Molecular Diagnostic Tests LCD which defines a Molecular Diagnostic test as non-covered if it meets the following criteria: Non-coverage policy...


Palmetto GBA, Medicare's Biggest Carrier, Proposes to End Code Stacking for Molecular Clinical Laboratory Tests

  • November 11, 2011

Palmetto GBA Identifies Coverage Criteria for Molecular Diagnostics Tests In Palmetto GBA's draft LCD, it states that, to be considered for reimbursement, specific molecular diagnostic tests must be explicitly covered by: a national coverage determination (NCD); a local coverage determination (LCD); or, a Palmetto GBA coverage article; As...


Labs "Very Nervous" About Palmetto GBA /CMS Contract, New Z-Codes and LCDs

  • November 3, 2011

This week I'm at the November meeting of the California Clinical Laboratory Association(CCLA.) Palmetto GBA announced that they obtained a new contract with CMS to develop a registry for Molecular diagnostic tests that would establish a new Z-code for each test using McKesson's proprietary software. The session generated almost an hour of Q&A...