CMS Administrator Touts Changes to RAC Program

  • Jul 8, 2019

Administrator Seema Verma recently highlighted changes to the Recovery Audit Program that are intended to make the program more provider friendly. Recovery Audit Contractors (RACs) review payments made to healthcare providers under Medicare Fee-for-Service plans. CMS will be providing better oversight of RACs in several ways, including by requiring RACs to have a 95% accuracy score. RACs also...

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Frequently Asked Questions: Technical Assessments for Next Generation Sequencing (NGS) Tests

  • Jul 8, 2019

Updated 6/27/2019 Question: Do we need to submit a TA for each single gene assay or sub-panel that is done as part of a larger hotspot panel, but with masking of the other genes? Answer: The TA must show that the test for which a claim is being submitted was validated. If the test was validated as part of the validation of a larger panel or platform validation, that is fine. If you...

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Medical Policy Updates - Regence

  • Jul 8, 2019

Commercial medical policies - changes effective July 1, 2019 Genetic Testing Chromosomal Microarray Analysis (CMA) for the Genetic Evaluation of Patients with Developmental Delay, Intellectual Disability, Autism Spectrum Disorder, or Congenital Anomalies (#58) Changed policy name Added to the medical necessity criteria testing of adults for the same indications as testing of pediatric...

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Texas Enacts Bill to Protect Consumers from Surprise Billing

  • Jul 8, 2019

On June 14, Texas joined the ranks of a score of states with consumer protections against surprise billing (or balance billing) with the signing of Senate Bill 1264. Effective this September, the bulk of the bill focuses on three areas: limitations on surprise billing information reported by consumer reporting agencies, elimination of surprise billing for specific health plans, and mandatory...

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Pathology Group Sets Expectations for DTC Genetic Tests

  • Jul 8, 2019

The Association for Molecular Pathology released an updated position statement with an expanded set of standards the group said should be met by providers of genetic tests marketed directly to consumers. Health-related claims must have well-established clinical validity, test providers must comply with CMS' Clinical Laboratory Improvement Amendments (CLIA) regulations, and board-certified...

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Vermillion Ovarian Cancer Test Gets Coverage From BCBS of Texas and Arizona

  • Jul 8, 2019

Vermillion said that its OVA1 ovarian cancer test will now receive preferred coverage from Blue Cross Blue Shield of Texas and Blue Cross Blue Shield of Arizona as an in-network covered test. OVA1 is a proteomic test that is meant to help doctors evaluate whether a patient with a pelvic mass is at high risk of having ovarian cancer and should be referred to a gynecologic oncologist for surgery.

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Medicare Address Match: Hospital Outpatient Denials Looming

  • Jul 8, 2019

Beginning in July, 2019, the Centers for Medicare & Medicaid Services (CMS) will direct Medicare Part A/B Macs to perform claim validation edits and return all claims to hospital providers if the address included on their claim forms do not exactly match the information included in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) system. Any discrepancy, such as the...

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AMP and CAP Comment on Palmetto Proposed Guidelines for NGS Testing of Myeloid Disorders

  • Jul 8, 2019

The Association for Molecular Pathology and College of American Pathologists released a letter commenting on Medicare administrative contractor Palmetto GBA's proposed coverage policy for MOLDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies. The organizations provided a list of genes they said they believe are clinically informative...

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