Billing News Feb 2020



MolDx Finalizes Expanded Coverage for Liquid Biopsies

  • February 10, 2020

The policy stipulates that WPSIC will only cover the Guardant360 assay if the patient has a recurrent, relapsed, refractory, metastatic, or advanced solid tumor that didn't originate from the central nervous system. The Medicare contractor further noted that patients who have an NTRK mutation and meet all the indications in the US Food...

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CMS Delays Clinical Lab Fee Schedule Data Reporting, Cuts Capped at 15% for 2021

  • February 10, 2020

Data that was set to be gathered between Jan. 1, 2020, and March 31, 2020, is now delayed until the period between Jan. 1, 2021, and March 31, 2021, after which reporting will continue on the normal three-year cycle, according to CMS. But PAMA cuts are set to continue in the meantime.  "Rather than waiting for the new data, however, CMS is...

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NIH to Establish Expert Panels for Curation of Disease-Linked Genes, Variants

  • February 10, 2020

The National Institutes of Health said that it intends to establish new expert panels tasked with identifying genes and genomic variants linked to high-priority disorders. The so-called Genomic Expert Curation Panels will use the National Human Genome Research Institute's Clinical Genomics Resource (ClinGen), as well as the National Center for...

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CMS to Launch New MIPS Participation Framework in 2021 Performance Period

  • February 10, 2020

CMS is implementing a new participation framework for the Merit-based Incentive Payment System (MIPS), called the MIPS Value Pathways (MVPs), starting with the 2021 performance period. The goal of this new framework is to move away from siloed performance category measures and activities, and move toward an aligned set of measures and activities...

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New Surprise Billing Legislation and Rules Go Into Effect on January 1

  • February 10, 2020

The Texas Department of Insurance promulgated emergency rules to implement SB 1264 on December 18, 2019, which then went into effect simultaneously with SB 1264’s other provisions on January 1, 2020. The emergency rules added additional detail and requirements to SB 1264’s other requirements. One additional requirement is that an out-of-network...

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Supreme Court Declines to Quickly Hear ACA Case

  • February 10, 2020

In a one-sentence order, the Supreme Court said Tuesday it will not rush to decide whether the landmark health law can stand. Though the law remains in place, the legal suit threatens access to insurance coverage and care for millions of Americans.   When Congress scaled back the financial penalty for forgoing insurance to zero,...

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MedTech Update 2020: Legal and Regulatory Issues to Watch For in the Medical Technology Industry in the New Year

  • February 10, 2020

Medical device and diagnostics companies and laboratories should anticipate significant legal, regulatory and market changes in 2020 that will have a lasting impact on the industry. From revisions to how the government regulates value-based care, to shifts in the marketplace for medtech mergers and acquisitions (M&A), 2020 will prove to be...

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BCBS - Starting May 1, Additional Radiology Procedures for Our Commercial, Medicare Plus Blue Members Will Require Prior Authorization

  • February 10, 2020

Beginning May 1, 2020, the PPO Radiology Management Program, administered by AIM Specialty Health®, will require prior authorization for additional radiology procedures. This change will apply to Blue Cross Blue Shield of Michigan commercial members, Blue Care Network commercial members, and Medicare Plus BlueSM members. Here are the...

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