Billing News Apr 2019



CMS to Revisit National Coverage Determination on NGS Tumor Testing

  • April 9, 2019

The Centers for Medicare & Medicaid Services will reopen a national coverage determination on next-generation sequencing panels to address the healthcare community's concerns about the negative impact the current policy would have on patients' ability to access genetic testing to learn their risk for cancer.   Based on the language...

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Guardant Health Liquid Biopsy Test Gets Draft LCD for Most Advanced Solid Tumors

  • April 9, 2019

Medicare contractor Palmetto GBA has proposed coverage for Guardant Health's 73-gene Guardant360 liquid biopsy test in more than a dozen solid tumor types where biomarker information is needed to inform their treatment. In a draft local coverage decision issued today, Palmetto said it would cover Guardant360 for advanced solid tumors when tissue-...

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The California Consumer Privacy Act Is Coming. Is Your Business Ready?

  • April 9, 2019

The California Consumer Privacy Act of 2018 (“CCPA”) was signed into law by Governor Jerry Brown on June 28, 2018 and goes into effect on January 1, 2020. The CCPA gives significant new data privacy rights to California residents with respect to their personal information that is collected and maintained by companies doing business in California....

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White House Proposes 12 Percent Cut to NIH Budget in Fiscal 2020

  • April 9, 2019

White House proposed a 12 percent decrease in funding to the National Institutes of Health as part of the White House's budget plan for fiscal 2020. In the proposal — called A Budget for a Better America — President Trump seeks $34.37 billion for the NIH in the coming fiscal year, a figure that includes $492 million in resources made available...

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Washington D.C. Attorney General Seeks Stronger Data Security And Breach Notification Requirementa

  • April 9, 2019

Add Washington D.C. Attorney General Karl A. Racine’s recent data security legislative proposal – the Security Breach Protection Amendment Act of 2019 – to the growing list of states and jurisdictions across the country seeking to strengthen privacy and security protections around personal information. Proposed in response to major data...

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NJ Amendment To Data Breach Notification Law, Moves To Governor

  • April 9, 2019

New Jersey General Assembly is taking steps to enhance the state’s data breach notification requirements.  In short, if signed, AB 3245, would require businesses to notify consumers of online account security breaches. New Jersey’s data breach notification law requires businesses to notify consumers of a breach of their personal information...

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Balanced Billing in California: Update Regarding 2016’s A.B. 72 and an Overview of Newly Introduced Bill A.B. 1611

  • April 9, 2019

Balanced billing or “surprise billing” has been getting increased attention at both the federal and state level. Balance bills arise when a payor covers out-of-network care, but the provider bills the patient for amounts beyond what the payor covers and beyond cost-sharing amounts. This article provides an update regarding two pieces of California...

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Medi-Cal Update: Targeted Genomic Sequence Analysis Panel Added as New Medi-Cal Benefit

  • April 9, 2019

Effective for dates of service on or after April 1, 2019, CPT code 81455 (targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm, DNA analysis, and RNA analysis when performed, 51 or greater genes, interrogation for sequence variants and copy number variants or rearrangements, if performed) is a Medi-Cal benefit. An...

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