Tuesday, May 26, 2026

How MACs Price Major Services That Lack Fixed RVU's (Case Study: PET CT)

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Header: AMA CPT has created some new Category III codes for whole-slide imaging proprietary tests.  However, as of May 26, CMS has NOT adde...

United Healthcare Publishes Variations from "Date of Service" Rule

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Medicare's date of service (DOS) rule for laboratory tests - often given the name, "14 day rule" - gets a new spin in a public...
Saturday, May 23, 2026

Upending the MAC System: Bold Idea Proposed for a Radically Different MAC

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Unhappy with your local MAC?  Waiting til you-know-where freezes over before they can issue a new LCD?   Anderson/Jackson/Miller have a new ...
Wednesday, May 20, 2026

Dunn Introduces H.R. 8890, Enhanced CLIA - Deja Vu Again

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There have been a few attempts at "Enhanced CLIA" legislation, and there's a new kid in town: H.R. 8890. It's introduced b...

Senate Resolution would put Part B Prior Auth (WISeR) on Chopping Block

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HEADER: A  new Senate resolution seeks to overturn CMS’s WISeR pilot.  This is the CMMI Medicare model that applies A I-supported prior auth...
Monday, May 18, 2026

Augmented AI and AMA Thinking: Wishful Thinking?

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There's a new paper going the rounds of commentary at Linked In: Open access; find it here . See comment at LinkedIn by Jan Beger here ....
Friday, May 15, 2026

Dr Bien-Willner Is Departing MolDx - An Update

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  Gabriel Bien-Willner to Transition Out of MolDX Medical Director Role May 15, 2025  (Columbia, SC) LinkedIn by GBW: here . Gabriel A. Bien...
Thursday, May 14, 2026

Digital Pathology Dollars. Re-live the Film-Digital Switchover at the RVU Ranch.

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What’s Past Is Prologue:  Medicare, Radiology, and the Strange Migration from Film to Digital ## The CMS-RVU migration from film to digital ...

Updated: Amal Thommil's MRD Roadmap

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 Amal Thommil of DeciBio updates his map of MRD coverage in oncology. Find it here: https://www.linkedin.com/posts/amalthommil_reimbursement...

AI Guest Column: Chat GPT on TROP2 CDx from Roche Diagnostics Day

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  A previous blog summarized the 3-hour, annual Roche Diagnostics Day. I asked Chat GPT to go back to the transcript and discuss the news a...

AI Guest Column: ChatGPT & Opus: Roche Diagnostics Day

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On May 12, 2026, Roche held its annual Diagnostics Day with a 3-hour webinar and a 150-slide deck. Find them here:   https://www.roche.com/i...

To Fix Software and AI Reimbursement - Do We Need to Understand the RUC?

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To Fix Software and AI Reimbursement - Do We Need to Understand the RUC? Maybe. For at least five years, CMS has had difficulty pricing soft...

Understanding FDA Regulatory Documents for Digital Pathology: PAIGE and ARTERA-AI

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We often hear there are 1000 FDA software/AI devices or SaMD for radiology, and only a few for pathology. Let's look at pathology, and s...
Monday, May 11, 2026

WISeR Prior Authorization - It's Worse Than We Knew. Case study: DBS in PD.

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Announced last summer, CMS has now instituted the WISeR program to force prior authorization into Medicare Part B using outside venders and ...

AI Guest Column: Will Genomics Move In-House or to Send-Out?

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Header: For years, one of the Grand Questions in genomics has been "in house versus send out."  I asked Claude Opus 4.7 to write ...