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This biweekly newsletter provides concise, independent coverage and analysis of fast-breaking lab, pathology, blood banking, imaging and diagnostic radiology news from the Nation's Capital.
You'll find out about:
- Medicare payment and policy directives Billing guidelines and coding changes for diagnostic facilities
- CLIA & MQSA regulatory mandates, changes and interpretations
- Congressional actions & legislative initiatives
- Federal compliance requirements
- OIG anti-fraud initiatives
- Stark self-referral prohibitions
Plus you will get other legal news regarding FDA oversight of in vitro diagnostics, blood banks, and radiological devices OSHA, NRC, and state safety standards.
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 | NIR August 14, 2006 (full PDF issue) |
| Q&As on how CMS plans to run the lab bidding demo
Medicare to mandate quality, e-health standards for providers
Labs included in final CMS/OIG rules on e-health safe harbors
Physician specialties tap insourcing to corner more pathology revenue; legal and ethical issues—see Focus
More details disclosed on Medicare’s ‘medically unlikely’ edits coming in January
CMS awards 1st consolidated MAC Part A/Part B contract
Medicare inpatient payments to increase, DRG changes to be phased-in
Medicare Coverage Advisory: Deductible waived for colorectal cancer screening under Part B
Washington Watch: Outpatient pay hikes proposed for 2007
Full Article |
| MD Specialties Aim for More Pathology Revenue |
| The insourcing of anatomic pathology work is a growing trend among certain physician specialties—in particular, urologists, gastroenterologists, and dermatologists—to add more ancillary services to their revenue stream. By bringing all or part of this work in-house, specialty groups can reap millions more dollars from Medicare and other third-party payers. Critics say this undercuts local pathology practices and usually requires pathologists to accept discounted fees.
Full Article |
| Medicare Lab Bidding Demo Set for April ’07 Launch |
| Medicare’s competitive bidding demonstration for independent clinical laboratory services payable under Part B is scheduled for launch in its first site on April 1, 2007, the Centers for Medicare & Medicaid Services has announced. A second demo is to begin in another site on April 1, 2008. At press time, CMS had yet to specify the sites. In both areas, the demo will run for three years.
Full Article |
| Labs Included in Final E-Health Safe Harbors |
| In recent final rules, the government has established new anti-kickback and Stark physician self-referral safe harbors that allow healthcare providers, including clinical laboratories, to provide electronic prescribing and electronic health record technology to physician referral sources.
Full Article |
| Medicare to Require Uniform Quality, E-Health Standards |
| Medicare and all other federally funded healthcare programs will soon require healthcare providers to adopt quality performance standards for a range of health conditions as well as uniform standards for interoperable health information technology, Health & Human Services Secretary Michael Leavitt told the National Governors Association on August 6.
Full Article |
| Physician Specialties Gobble Up More of the Pathology Pie |
| You’ll see it popping up lately around the country—it’s called "insourcing" anatomic pathology services. Certain physician specialties—most notably, urologists, gastroenterologists, and dermatologists—are using this business arrangement to capture ancillary revenue from work done by pathologists.
Full Article |
| CMS to Contractors: Get Ready for ‘Medically Unlikely’ Edits |
| Starting January 1, 2007, local Medicare contractors are to implement the first round of "medically unlikely" edits (MUEs)—the new name for the old "medically unbelievable" edits. MUEs are limits on the units of service that a healthcare provider can bill a particular CPT/HCPCS code per Medicare beneficiary per day. Claims exceeding the limits will be automatically denied.
Full Article |
| Medicare Hikes Inpatient PPS Rates, Starts DRG Changes |
| Medicare payments to acute-care hospitals for operating expenses will rise 3.4% on average, or $3.4 billion, in fiscal year 2007, which begin this October 1, the Centers for Medicare & Medicaid Services has announced, The final 2007 inpatient PPS rule is scheduled to appear in the August 18 Federal Register. More than 1,000 rural hospitals will see a 3.7% average increase; urban hospitals less, 3.4%, CMS estimates. Cardiac specialty hospitals will see only a 1.2% increase as part of reduced incentives to select and provide only profitable services.
Full Article |
| 1st Contract Awarded for Combined Part A/B Claims Processing |
| Noridian Administrative Services (Fargo, ND) has been awarded the first competitively bid contract to serve as a Medicare Administrative Contractor (MAC) under a new structure that consolidates Part A/B claims processing and payment, replacing the current system that splits the work between fiscal intermediaries and carriers.
Full Article |
| Deductible to Be Waived for Colorectal Cancer Screening |
| Starting January 1, 2007, Medicare will waive the annual Part B deductible for certain colorectal cancer screening procedures covered under the program’s preventive services package. The waiver implements a requirement in the Deficit Reduction Act of 2005, said the Centers for Medicare & Medicaid Services (CMS Change Request 5127, July 21, 2006). Co-pay requirements will continue to apply.
Full Article |
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