Billing News Aug 2018



With CMS coverage policy, NGS cancer testing goes large

  • August 2, 2018

The NCD makes all NGS testing (including leukemia/lymphoma, germline, liquid biopsy tests, and more) for patients with advanced-stage cancer eligible for pathways to FDA approval and CMS coverage. It drops a requirement that the tests be backed by evidence development, and it expands the eligible patient population to patients with stage III and...

Read



Preliminary But Maybe

  • August 2, 2018

New clinical trial designs and precision medicine may lead to new treatments for Alzheimer's disease. Supported by FDA Commissioner Scott Gottlieb — preliminary results suggest that patients treated with the highest amounts of BAN2401 exhibited the greatest decline in amyloid plaques.

Read



Laboratory Date of Service Exception - 6-Month Enforcement Discretion Period Announced for Date of Service Exception

  • August 2, 2018

The Centers for Medicare & Medicaid Services' Center for Medicare (CM) announced that it will exercise enforcement discretion until January 2, 2019, with respect to the laboratory date of service (DOS) exception policy at 42 CFR 414.510(b)(5) under the Medicare Clinical Laboratory Fee Schedule (CLFS). During the enforcement discretion period,...

Read



New Waived Tests - Effective Date: October 1, 2018

  • August 2, 2018

CR10819 describes the latest tests approved by the FDA as waived tests under CLIA. The Current Procedural Terminology (CPT) codes for the new tests in the table below must have the modifier QW to be recognized as a waived test. However, the following tests do not require a QW modifier to be recognized as a waived test: CPT codes: 81002, 81025,...

Read



Laboratory NCD Edit software Changes for October 2018

  • August 2, 2018

Announces the changes that will be included in the October 2018 quarterly release of the edit module for clinical diagnostic laboratory services. The changes are a result of coding analysis decisions developed under the procedures for maintenance of codes in the negotiated NCDs and biannual updates of the International Classification of Diseases,...

Read



CMS ends risk-adjustment freeze, releasing $10.4B to insurers

  • August 2, 2018

The final rule (PDF), released by the Centers for Medicare & Medicaid Services (CMS) on maintains the same methodology for risk-adjustment transfers previously outlined by the agency, using statewide average premiums as part of the formula. CMS included an additional explanation in the rule on the formula.  For the 2018 and 2019...

Read



Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

  • August 2, 2018

New codes will be contractor-priced, until they are addressed at the annual Clinical Laboratory Public Meeting, which will take place in July 2018. CR: 10875

Read



CMS Empowers Patients and Ensures Site-Neutral Payment in Proposed Rule

  • August 2, 2018

On July 25, CMS took steps to strengthen the Medicare program with proposed changes to ensure that seniors can access the care they need at the site of care that they choose. The proposed rule aims to address other payment differences between sites of service, so that patients can choose the setting that best meets their needs among safe and...

Read