Industry Notes: CMS Adds 16 Lab Tests to CLIA-Waived Status

Why This Topic Matters

The update helps practices and billing teams stay aware of payer changes that can affect claim submission, payment status, and administrative compliance. It also flags operational issues and deadlines that may influence whether claims are paid correctly or require follow-up.

Article Sections

1. CLIA-waived lab test update

   Discusses a CMS transmittal and related reporting changes for laboratory tests. It also notes the use of a modifier tied to waived testing.

2. Vaccination reimbursement issue

   Addresses a Medicare pricing problem affecting influenza vaccine claims and the handling of resulting appeals or adjustments.

3. E-prescribing penalty timing and hardship guidance

   Explains upcoming payment adjustments tied to e-prescribing participation and summarizes CMS communications about hardship applications and review timing.

4. Home health reimbursement and regulatory pressures

   Reviews factors contributing to home health agency closures, including reimbursement and regulatory changes in Medicare and Medicaid environments.

5. Claims system glitches affecting processing

   Summarizes reported MAC system issues that affected billing transactions, suspensions, and rejections, along with anticipated correction steps.

6. Hospice billing education for referring physicians

   Highlights provider education efforts intended to improve hospice referrals and clarifies the availability of external billing resources.