News

  • Representative Sample of Tests No Longer Covered by TRICARE

    February 10, 2014
      Note: this is not a comprehensive list. For additional reading on this issue, please see the following articles: “DHA operations chief vows some relief from surprise lab fees,” Stars and Stripes, Feb. 6, 2014 “Some lab fees soon will be billed to Tricare patients,” Stars and Stripes, Jan. 9, 2014 Download PDF...
  • DHA operations chief vows some relief from surprise lab fees

    February 06, 2014
    Army Maj. Gen. Richard W. Thomas, newly assigned as chief medical officer and director of healthcare operations for the new Defense Health Agency (DHA), acknowledges that some Tricare patients and their civilian physicians face lab fee challenges that the DHA needs to address. A year ago Tricare, the military’s health insurance program, quietly stopped reimbursing civilian laboratories for more than 100 genetic or laboratory-developedContinue Reading »...
  • Pay cuts could wipe out labs, hurt nursing homes

    February 05, 2014
    When it comes to worries about how Medicare doctors will be paid, nursing home operators have thought they should stand at the front of a long and anxious line. Truth be told, they have some stiff competition for the “most nervous” title. That might go to the clinical lab folks. Although many provider groups are worried about which will have to sacrifice the mostContinue Reading »...
  • A Statement from the American Clinical Laboratory Association (ACLA) on the HHS-CMS Final Rule Allowing Patients Direct Access to Personal Laboratory Results

    February 04, 2014
    On behalf of ACLA — a not-for-profit association representing the nation’s leading national and regional clinical laboratories on key issues of common concern, including federal and state government reimbursement and regulatory policies – ACLA President Alan Mertz issued the following statement: The ACLA today expressed its support for a new regulation issued by the Department of Health and Human Services (HHS), to be released inContinue Reading »...
  • ACLA Comments on Gapfill Reconsideration Period for BRCA 1 & 2

    January 24, 2014
    January 24, 2014 Mr. Marc Hartstein, Director Hospital and Ambulatory Policy Group Center for Medicare Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, Maryland 31344 MoPathGapfillInquiries@cms.hhs.gov RE: Notification of Reconsideration Period – 2013 Gapfill Payment Amounts Dear Marc, Please accept the comments of the American Clinical Laboratory Association (“ACLA”) on the Notification of Reconsideration Period – 2013 Gapfill Payment Amounts for molecularContinue Reading »...
  • Tricare users will soon pay more for some medical tests, maintenance medications only available through mail

    January 13, 2014
    Tricare beneficiaries will soon pay more for some diagnostic genetic tests ordered by their civilian physicians – including procedures used to detect cystic fibrosis or determine cancer treatments – if the Defense Health Agency deems them to be medically unnecessary. Stars and Stripes is reporting Tricare stopped reimbursing clinical laboratories in January 2013 for more than 100 different genetic or molecular pathology tests. The laboratoriesContinue Reading »...
  • MILITARY UPDATE: Some lab fees soon will be billed to Tricare patients

    January 11, 2014
    TRICARE beneficiaries soon will have to pay out of pocket for certain diagnostic genetic tests their civilian physicians order but the Defense Health Agency doesn’t view as appropriate or medically necessary. In January 2013, without notice to beneficiaries or to health care providers, TRICARE stopped reimbursing clinical laboratories for more than 100 different genetic or “molecular pathology” tests. Beneficiaries haven’t complained yet because theContinue Reading »...
  • Some lab fees soon will be billed to Tricare patients

    January 09, 2014
    Tricare beneficiaries soon will have to pay out of pocket for certain diagnostic genetic tests that their civilian physicians order, but that the Defense Health Agency doesn’t view as appropriate or medically necessary. In January 2013, without notice to beneficiaries or to health care providers, Tricare stopped reimbursing clinical laboratories for more than 100 different genetic or “molecular pathology” tests. Beneficiaries haven’t complained yetContinue Reading »...
  • ACLA Letter to CMS Regarding Gapfill Payment Rates for BRCA1 and BRCA2 Sequencing

    December 31, 2013
    Jonathan Blum Principal Deputy Administrator Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Dear Mr. Blum: On behalf of the American Clinical Laboratory Association (“ACLA”), we are writing to express our strong objection to CMS’s recent action establishing a new reduced price for CPT code 81211 (BRCA1 and BRCA2 sequencing) as part of the gapfill price-setting process. As discussed below,Continue Reading »...
  • OIG And CMS Permit EHR Donations Through 2021, Except For Labs

    December 27, 2013
    At long last, the Office of Inspector General for the Department of Health and Human Services (OIG) and the Centers for Medicare & Medicaid Services (CMS) have finalized regulations amending the Anti-Kickback Statute safe harbor and the Stark Law exception, respectively, for donation of electronic health records (EHR) items and services. As I explained in a previous post, CMS and OIG had proposed to extend theContinue Reading »...