Billing

The American Society for Clinical Pathology (ASCP) recently shared its recommendation for pricing new laboratory tests with the Centers for Medicare & Medicaid Services (CMS).

The ASCP's recommended 2017 clinical laboratory billing rates can be viewed here.

They were outlined at a July meeting with CMS by ASCP Past President Dr. Lee Hilborne.

The recommendations covered a series of new molecular assays, genomic sequencing procedures and other CPT codes added to the Medicare Clinical Laboratory Fee Schedule. As ASCP notes,  many of its recommendations focused on crosswalking the new tests or revised CPT codes to existing tests that require similar resources and are technologically similar.

The Centers of Medicare & Medicaid Services (CMS) has reported in its MLN Connects Provider eNews that it is denying many chiropractic claims because they fail to meet Medicare’s requirements.

During the 2015 reporting period, CMS notes that the Medicare fee-for-service improper payment rate for chiropractic services was 51.7 percent, representing approximately $300 million in chiropractic billing improper payments.

The most common reason for the improper payments is insufficient documentation to support the billed services. CMS states that this type of error occurs when the medical records do not contain enough information for the reviewer to make a decision about medical necessity for the item or service furnished.

To avoid denied claims and overpayment recovery, CMS advises practices to take the time to understand Medicare's requirements, particularly concerning documentation requirements and medical necessity.

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