- Joined
- Sep 9, 2004
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Does anyone have a handle on what the HELL is going on with the LCD shenanigans the CMS intermediaries are trying to pull? This borders on ridiculous and I am a complete loss on how they actually plan to enforce any of this crap.
From my reading to summarize:
If a prostate core ends up being negative after a PIN4, they aint paying.
If a gastric biopsy has H. Pylori IHC done, even if requested by the GI doc specifically, they aint paying.
If a breast case has the breast triple stain done, they aint paying.
If you order Ki-67 for almost any reason outside of some lymphomas, they aint paying.
If you order more than 2 (yes 2..) stains for lung carcinoma, they aint paying.
WHAT THE HELL IS HAPPENING?
Is this for real? I realize CAP is trying to a legislative work around but how in the heck are the intermediaries granted some incredibly broad power to simply deny payment to wide swaths of Medicare/Medical patients' care? We have CMS itself lowering payments and the fiscal intermediaries then compounding the situation with literally denying all the payments out of hand.
This is the G.D. apocalypse!
From my reading to summarize:
If a prostate core ends up being negative after a PIN4, they aint paying.
If a gastric biopsy has H. Pylori IHC done, even if requested by the GI doc specifically, they aint paying.
If a breast case has the breast triple stain done, they aint paying.
If you order Ki-67 for almost any reason outside of some lymphomas, they aint paying.
If you order more than 2 (yes 2..) stains for lung carcinoma, they aint paying.
WHAT THE HELL IS HAPPENING?
Is this for real? I realize CAP is trying to a legislative work around but how in the heck are the intermediaries granted some incredibly broad power to simply deny payment to wide swaths of Medicare/Medical patients' care? We have CMS itself lowering payments and the fiscal intermediaries then compounding the situation with literally denying all the payments out of hand.
This is the G.D. apocalypse!
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