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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 December 15, 2006 (full PDF issue) |
| Congress extends pathology ‘grandfather’ protection for another year
Medicare sets final fees for new 2007 CPT lab codes
Preview of key Medicare changes affecting clinical labs, pathologists in ‘07—see Focus
—New & revised coverage policies
—Final payment rates
—Launch of MUEs
—National provider ID
—New claims processing MACs
Pathology, oncology groups issue guideline on HER2 testing for breast cancer
CLIA Advisory: New waived tests
Medicare overpayment recovery project to go nationwide
Washington Watch: von Eschenbach confirmed as permanent FDA head
Full Article |
| CMS Finalizes 2007 Lab Fee Schedule |
| The Medicare Part B lab fee schedule for 2007, released earlier this month, provides a zero update, keeping fees at their 2003 level in accord with the statutory five-year freeze on fee updates through 2008. The freeze also keeps the national minimum payment for Pap smears at $14.76.
Full Article |
| Pathology Escapes SGR Fee Cut, but Not Other Reductions |
| While pathologists are spared the 5% cut in Medicare physician payments scheduled to take effect January 1, 2007, under the statutory update formula, they still face a 6% reduction next year in total allowed charges due to regulatory changes to work and practice expense relative value units (RVUs) under the Part B physician fee schedule. For independent labs, however, the RVU changes translate to a gain of 2%. For diagnostic testing facilities, they translate to a cut of 2%.
Full Article |
| ‘Grandfather’ Protection Extended for Pathology TC Billings |
| As part of the Tax Relief and Health Care Act of 2006 enacted in the waning hours of the lame-duck session, Congress extended for one year, through 2007, the "grandfather" protection under which independent clinical labs are allowed to bill Medicare Part B directly for the technical component (TC) of pathology services to hospital inpatients and outpatients. The protection was due to expire at the end of this year, and in the final 2007 physician fee schedule, the Centers for Medicare & Medicaid Services announced plans to eliminate it.
Full Article |
| What’s Ahead for Clinical Labs, Pathologists in ’07? A Quick Guide to Key Medicare Policy Changes |
| Effective January 1
1. Medicare Coverage
New Test Codes on the Lab Fee Schedule
Eleven new CPT lab codes will be added to the Part B lab fee schedule. They include three in chemistry, two in immunology, and six in microbiology (see table). Also added: an existing CPT blood typing code.
Full Article |
| New Waived Tests & Billing Codes |
| Listed below are the latest tests approved by the FDA as waived tests under CLIA. The CPT codes for the following new tests must have the modifier QW to be recognized as a waived test, effective January 1, 2007:
Full Article |
| New Practice Guideline for HER2 Testing for Breast Cancer |
| The College of American Pathologists and the American Society of Clinical Oncology on December 11 announced the release of a clinical practice guideline to improve the accuracy of HER2 testing for breast cancer patients and to guide therapy selection. This is the first time the two groups have joined to address a critical issue affecting all patients with a new diagnosis of invasive breast cancer, said CAP and ASCO in a joint statement.
Full Article |
| After Contentious Struggle, FDA Gets Permanent Head |
| In one of his final acts as Senate Majority Leader, Bill Frist (R-TN) overrode the time-honored tradition of senatorial holds, plus members of his own party, and allowed a Senate vote on the President’s nomination of Andrew von Eschenbach to be permanent Commissioner of the Food & Drug Administration. He has been acting commissioner for the past year.
Full Article |
| Medicare Recovery Audit Project to Go Nationwide |
| Healthcare providers billing Medicare will come under greater scrutiny now that Congress has extended the recovery audit project and is expanding it to all states. Currently, the project is a demo operating in California, Florida, and New York. Its aim is to identify and collect inaccurate Medicare overpayments and underpayments using six specialized Recovery Audit Contractors (RACs).
Full Article |
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