Billing News Mar 2014



House Passes SGR Bill

  • March 27, 2014

Moments ago the House passed the SGR Bill. Please find links to a copy of the Bill and a bullet point synopsis of the key points affecting labs, below.  CBO also just released its score on the legislation indicating an anticipated savings of $2.5 billion from 2014-2024 to lab payments, which is lower than earlier estimates.  The Bill...

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Update to 2014 Hospital Outpatient Clinical Diagnostic Laboratory Test Payment and Billing

  • March 18, 2014

In the January 2014 update to the Hospital Outpatient Prospective Payment System (OPPS), CMS implemented a new policy under the 2014 OPPS final rule, providing packaged payment of outpatient lab tests (other than molecular pathology) under the OPPS rather than separate CLFS payment, effective for dates of service on or after January 1, 2014. In...

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ICD-10 Limited End-to-End Testing with Submitters

  • March 18, 2014

This article instructs providers and clearinghouses on how to volunteer to be chosen for ICD-10 end-to-end testing with Medicare in July 2014. Potential testers must complete the volunteer form on the MAC website by March 24, 2014. To facilitate this testing, this CR requires MACs to do the following: Conduct a limited end-to-end testing with...

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President’s Budget for 2015 Recommends Exclusion of AP Services From the IOAS Exception

  • March 18, 2014

After many years of leading the charge against the self-referral of anatomic pathology (AP) services, the College of American Pathologists (CAP) is pleased that President Obama’s budget proposal for 2015, released March 4, for the first time recommends the exclusion of AP services from the “In-Office Ancillary Services” (IOAS)...

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ICD-9 to ICD-10 Local Coverage Determination Crosswalk

  • March 18, 2014

Palmetto has created a ICD-9 to ICD-10 Local Coverage Determination Crosswalk of all LCD policies currently in effect. It contains the current ICD-9 policy number and the future ICD-10 policy number. MAC J11 for North Carolina, South Carolina, Virginia and West Virginia

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Diagnostic Restrictions for Chlamydia Trachomatis and Neisseria Gonorrhoeae

  • March 18, 2014

Effective for dates of service on or after April 1, 2014, additional diagnostic restrictions for CPT code 87491 (Chlamydia trachomatis, amplified probe technique) and CPT code 87591 (Neisseria gonorrhoeae, amplified probe technique) testing are required on Family PACT (Planning, Access, Care and Treatment) claims unless otherwise noted....

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Removal of Patient Age Restrictions for Two Tuberculosis Test Codes

  • March 18, 2014

Effective for dates of service on or after March 1, 2014, the minimum patient age for reimbursement with CPT codes 86480 (tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon) and 86481 (tuberculosis test, enumeration of gamma interferon-producing T-cells in cell suspension) is lowered from 5 to 0 years.

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Updated Prior Authorization Forms for Texas Medicaid and CSHCN Available in March

  • March 18, 2014

Effective March 17, 2014, all prior authorization forms for Texas Medicaid and the Children with Special Health Care Needs (CSHCN) will be updated and available on the website. The prior authorization forms have been updated to accommodate the reporting needs for ICD-10. The prior authorizations will be approved based on the diagnosis appropriate...

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