Billing News Feb 2019



New Waived Tests

  • February 12, 2019

The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations require a facility to be appropriately certified for each test performed. To ensure that Medicare & Medicaid only pay for laboratory tests categorized as waived complexity under CLIA in facilities with a CLIA certificate of waiver, laboratory claims are currently edited...

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Guidance on Coding and Billing Date of Service on Professional Claims

  • February 12, 2019

The article does not present any new or revised Medicare policy. Instead, the article reiterates the current Medicare policy. This information concentrates on the date(s) of service to submit when billing for these services. The Medicare Benefit Policy Manual, Chapter 15, Section 20 shows that expenses are considered to have been incurred on the...

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Calendar Year (CY) 2019 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

  • February 12, 2019

New Codes Effective January 1, 2019 Proprietary Laboratory Analysis (PLAs) The following new codes have been included in the national HCPCS file correction with an effective date of January 1, 2019 and may need to be manually added to the HCPCS file by the MACs. These new codes are also contractor-priced until they are addressed at the annual...

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Calendar Year (CY) 2019 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

  • February 12, 2019

The revised CR deleted code 0008U from the list of revised codes effective January 1, 2019. Next CLFS Data Collection Period: Section 1834A of the Social Security Act (“the Act”), as established by Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), required significant changes to how Medicare pays for Clinical Diagnostic...

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CMS Increases CLIA Certification Fees By 20% Effective Immediately

  • February 12, 2019

CMS recently announced a 20 percent increase to the fees that laboratories must pay when certified under the Clinical Laboratory Improvement Amendments (CLIA) of 1988.  This is the first such increase in the last 20 years and is meant to address the significant CLIA program administration shortfall that has developed over time.  The...

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Pathologist Group Asks Medicare to Reconsider Payment for BRCA Genetic Testing CPT Codes

  • February 12, 2019

The Association for Molecular Pathology has asked Medicare to increase the payment amounts for two CPT codes attached to testing procedures for BRCA1 and BRCA2 genes by considering the work and resources that labs invest in analyzing these large and variable genes.  The Centers for Medicare & Medicaid Services in December 2018 released...

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CMS Announces Extension of Enforcement Discretion Period for Laboratory Date of Service Exception Policy Under the Medicare Clinical Laboratory Fee Schedule Until July 1, 2019

  • February 12, 2019

The Centers for Medicare & Medicaid Services (CMS) announced that it will exercise enforcement discretion for an additional six (6) months, until July 1, 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...

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CMS to Expand Tailored Benefits for Medicare Advantage Plans

  • February 12, 2019

CMS is proposing significant changes to Medicare Advantage geared towards expanding choice and increasing competitiveness in a highly lucrative market. The proposals would increase the number and scope of supplemental benefits available to Medicare Advantage (MA) members and would open up the option of tailoring benefit packages to patients with...

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