tag:blogger.com,1999:blog-83343212718272177592026-09-14T00:56:49.211-07:00Discoveries in Health PolicyIdeas for or from an evolving healthcare systemBrucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comBlogger3506125tag:blogger.com,1999:blog-8334321271827217759.post-82470277659078353012026-09-13T16:10:34.832-07:002026-09-13T16:10:34.832-07:00Genomeweb: Alarm Over CMS Rule on Lab Algorithms See a subscription article at Genomeweb about "algorithm only testts." By Adam Bonislawski, 9/11/26, here:https://www.genomeweb.com/business-news/reimbursement/gnw-cms-acla-ai-reimbursement-20260910/I covered the comments of the top organizations in a September 2 blog:https://www.discoveriesinhealthpolicy.com/2026/09/opps-rule-ditching-digital-pathology.html####Genomeweb cites public Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-85885318509890538252026-09-13T15:20:35.538-07:002026-09-13T15:20:35.539-07:00Do Current Fraud Press Releases Flag the Pending CRUSH Regulation? Last winter, CMS introduced the CRUSH anti-fraud program, with an RFI in the Federal Register. Since August 2026, that has matured to a proposed regulation that is percolating in review at OMB/WH. But we just saw a flurry of CRUSH-CRIME press releases from CMS. Do those press releases flag themes we'll be reading soon in CRUSH? Let's look into it.##Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-83702930015041155922026-09-13T15:15:49.809-07:002026-09-13T15:15:49.809-07:00The Evergreen HHS Press Release: Recyling Rural Health Investment NewsHeader: In July 2025, Congress passed a huge tax bill that included $billions in spending for rural health, especially rural health technology. We show how HHS keeps the "news" surprisingly evergreen, including a flood of recent press releases.### The Evergreen Press Release: How One Rural Health Appropriation Keeps Becoming New NewsThe money is real. The projects are real. But Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-19014022939235988532026-09-10T05:40:50.698-07:002026-09-13T15:23:47.196-07:00AMA CPT Asks Weird Social Equity Questions; RFK Jr Goes on AttackIt's no secret that AMA CPT applications are full of now-sounds-dated language about whether an applicant's CPT code "perpetuates social bias" (? structural racism) and (even worse) "propagates" it. (No, sir, I'm just measuring potassium). Now RFK Jr has launched a direct attack on AMA CPT as a "Monopoly" which favors "special interests" and he asks the American Public to Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-13286657176011771922026-09-09T15:01:06.824-07:002026-09-10T15:35:16.580-07:00You Better Learn the Biggest Myth About Payor Coverage of Diagnostics "The Coverage Myth in Diagnostics"In an interview, I was asked, "What's the biggest myth you hear repeated?' That led to the (AI assisted) essay below. For representative entry points, here, here, here, here. Traditional view of "the payer mind" here and here (both POC). ADVI, on need for integrated reimbursement planning here. So I maintain that the Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-49223896888706181972026-09-09T14:45:26.526-07:002026-09-09T14:45:26.527-07:00AI Corner: The strange path to remote monitoring coding, and the latest twist Somone asked me about the "complexified" coding of remote monitoring, a current hot topic at CMS.I'm not a native expert, so I asked Chat GPT for some orientation. As below.## From Holter to Remote Monitoring: How a Simple Coding Logic Produced 17 Codes—and Why CMS May Collapse Them to FourThe current RPM and RTM code families can appear bewildering to anyone entering the subjectBrucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-79433642996394599962026-09-07T12:44:29.890-07:002026-09-07T12:44:29.890-07:00AI Guest Author: A New Report on Better External Control Arms via N-Power Medicine Series B I saw a headline that N-Power Medicine, which promises new ways to do oncology trials, had raised $32M by large investors, including LabCorp. Their game is a next-generation approach to "external control arms," or ECAs, for clinical trials. I've run across ECAs at regular intervals, and I asked Chat GPT to provide me an update, in the form of a report.Happy to share Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-2147880677155183512026-09-06T11:11:40.360-07:002026-09-06T11:37:51.845-07:00Humor: From Cocktail Napkin Scribble to Sophisticated DiagramLast week, I published a white paper arguing that the "transformation event" in digital pathology will be when AI can read slides, and write reports, and present them for validation to the pathologist. (FDA has recently approved software that can do this for certain applications within radiology, while saving 40% of radiologist time to review rather than write.)Blog here. Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-71795004628651476232026-09-06T09:02:26.946-07:002026-09-06T10:14:23.480-07:00AMA Lab Code Application Revisions are Large and ImportantHeader: Tab 94 for the next AMA CPT Editorial Meeting proposes massive revisions to the code change application (CCA) for laboratory/pathology services. You may want to track - and you can!##See the webpage for the AMA CPT September 17-18 meeting here.See the public agenda here. Tab 94, code change application (for the laboratory-pathology Category I, III codes).The request Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-44492639583847750312026-09-06T08:14:34.018-07:002026-09-06T08:24:28.472-07:00AMA's Appendix S: Don't Incorporate Into Code Decisions Until it is FixedHeader: As we prepare for the September AMA CPT meeting in Minneapolis, one proposal brings new "Appendix S" strongly into the Category I, Category III Code Change Application (MSP Tab 94). But "Appendix S" has major flaws as a classification architecture, and it should be fixed before importing it any further into CPT operations. A new 10-page white paper explains it Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-75777014446704512402026-09-03T15:28:31.130-07:002026-09-03T15:29:05.135-07:00Humor: Sorry We Have No Design SuggestionsSorry, We have No Design Suggestions For This Slide.(click to enlarge)Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-87685774797816985272026-09-03T08:22:43.957-07:002026-09-03T08:23:00.145-07:00FDA is Really Doing It: Downclassify CDx based on ISH-FISH (August 2026) FDA Quietly Moves Oncology ISH/FISH Companion Diagnostics From PMA to 510(k)A Biden-era deregulatory promise survives the LDT court loss — and continues under the Trump FDAOn August 17, 2026, FDA did something that should matter to almost anyone following oncology companion diagnostics: it reclassified a defined family of oncology in situ hybridization (ISH) companion diagnostic tests from Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-9834803212263157932026-09-03T07:59:55.250-07:002026-09-04T12:20:34.202-07:00MolDx Issues Bonanza of New LCDs in Late August 2026 MolDx issues a bonanza - a triplet - of new proposed LCDs.Two provide defined coverage. One general NGS LCD for heme malignancies, one for whole genome mapping in heme neoplasms.The renal biomarker LCD finds that there is much activity in the field but that the power or utility of the stratification biomarkers do NOT yet meet MolDx standards for coverage. Expect brisk Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-47289178327434125872026-09-02T15:50:09.672-07:002026-09-02T15:50:09.673-07:00MolDX MACs Delay Finalization of Prelude DCISion-RT LCDMolDx released a draft non coverage LCD for the DCISion-RT test last year, and it's not finalized yet.It may be a while: they've announced an official delay.https://www.cgsmedicare.com/parta/pubs/news/2026/07/news-206951.html####July 13, 2026Notice Regarding MolDX: Biomarker Testing for Risk Stratification in DCIS (DL40246)Medicare Administrative Contractors (MACs) carefully considered all Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-40871340614229727512026-09-02T10:23:29.467-07:002026-09-05T07:22:57.751-07:00OPPS Rule: Ditching Digital Pathology from CLFS and CLIA? Stakeholder Organizations Comment(Rapid AI Blog)This summer, in both OPPS and PFS proposed rules, CMS proposed to "nix" software-intensive lab services from the CLFS and perhaps even from CLIA. (Concurrently, but no coincidence, CLIA held a Request for Information on moderning CLIA, including open-ended questions about the status of digital-only and software-intensive services.)This is a 180-degree position relative to AMABrucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-8438922000092575672026-09-01T09:49:10.169-07:002026-09-03T17:24:52.747-07:00Is Digital Pathology Close to the BIllion-Dollar Explosion in Value?Mini Summary:Structured pathology reporting is quietly laying the
groundwork for AI-generated reports. We argue that this will transform digital
pathology from image digitization into a productivity engine—and triggering its
long-awaited billion-dollar hockey stick for digital pathology. Find the white paper here.Full Summary:Digital
pathology has largely been evaluated at the front end of Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-80283637263259004862026-08-30T14:27:45.107-07:002026-09-03T12:22:12.568-07:00You've Never Seen This: The CMS Digital Pathology Rule as Exciting "Harvard Case Study" New from Discoveries in Health Policy (DHIP)##This DHIP Case Study uses the Harvard Business School approach to make an unusually dense Medicare policy dispute come alive through personalities, institutional stakes, and a real-time strategic dilemma. In this fictional case, Jill Tillman, newly promoted at CAP, must respond by August 31—before seeing how other stakeholders have lined upBrucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-2512989620260257942026-08-26T18:58:28.290-07:002026-08-26T18:58:28.291-07:00Piling on to Software as a service; MEDPAC Plans Everyone's piling onto Software as a Medical Service (SaMS), and related terms. AMA CPT has been working on its Appendix S software coding paradigms. CMS in July offered radical changes to come, beginning with a new acronym, SaMS. Now the advisory body MEDPAC piles on.Here's how Google Gemini summarizes some new MEDPAC initiatives:The MEDPAC agenda specificallyBrucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-89583406645056437022026-08-26T13:00:09.103-07:002026-08-26T14:34:45.987-07:00Revisited: CAP and CMS Go in Opposite Directions on Digital PathologyIn July rulemaking, in both OPPS (hospital outpatient) and Physician (aka Part B) proposed rules, CMS announced it will evict digital pathology / computational pathology services from CLIA services, and therefore strip them of their position on the Clinical Laboratory Fee Schedule.Whether you love or hate CLIA, love or hat the CLFS, my reading of the SSA 1834A PAMA statute is that "clinical Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-54908253209843924582026-08-26T10:47:32.516-07:002026-08-26T10:47:32.517-07:00Very Brief Blog: CMS OPPS CY2027 Comment Due Aug 31There was a lot of action in summer rulemaking - both the OPPS and PFS (outpatient & physician part b) rules.The deadline for comment on the OPPS policies is Monday, August 31.Find it here:https://www.federalregister.gov/documents/2026/07/07/2026-13656/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-paymentBroad actions include new policies for "Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-78993880191942639742026-08-26T10:29:45.681-07:002026-08-26T11:43:39.015-07:00AI Reviews: ADAPT OR BECOME IRRELEVANT - Alternative Visions for PathologyYou may have seen it cited on Linked In - a new position paper on the future of pathology called, “Adapt or Become Irrelevant: The Pathologist as the New Diagnostic Architect.” It is co-authored by Mariano De Socarraz, MD, Founder and CEO of CorePlus, and Jochen K. Lennerz, MD PhD, Medical Director for Pathology Innovation at Natera.See a Linked In article here.See the original article Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-81251790064892472892026-08-25T07:52:18.162-07:002026-08-25T08:46:36.795-07:00AI Guest Author: Waiting for CRUSH Regulations from OMB CRUSH at OMB: The Next Stage of a Twenty-Year Medicare Anti-Fraud CampaignAI Corner: Chat GPT 5.6; 8-25-2026The next major Medicare and Medicaid program-integrity proposal is now under review at the Office of Management and Budget. OMB’s public record shows that it received the proposed Comprehensive Regulations to Uncover Suspicious Healthcare, or CRUSH, rule from CMS on August 7, 2026. Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-53953520073704655652026-08-23T17:29:39.427-07:002026-08-23T17:39:39.532-07:00CRUSH Reaches White House / OMB, Who Will Release the Proposed Regulations NEWS: CMS Sends Major CRUSH Anti-Fraud Rule to OMBThe February request for information has quietly become an actual proposed rule, with new Medicare enrollment and enforcement provisions potentially only weeks away.A major anti-fraud regulatory proposal is on the desk of management officials at the White House Office of Management and Budget, awaiting signoff for publication.CMS transmittedBrucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-81156092754286338822026-08-22T16:55:20.544-07:002026-08-23T20:24:19.376-07:00Blog 5 of 5: AI Rewrites My Human Blog #3 (88305 Super-Providers)In this series of 5 blogs, Blog 3 (national and super-provider utilization) was written by Quinn by hand. Here is Blog 3, rewritten from source material entirely by Chat GPT 5.6.###88305: Blog 5 of 5 — What Medicare’s Biggest Users Tell Us About the 25-Minute ProblemThe developing Medicare controversy over CPT 88305 can be approached from two directions. The Maryland Health Care Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.comtag:blogger.com,1999:blog-8334321271827217759.post-34575146005537399732026-08-22T16:27:13.757-07:002026-08-23T17:40:00.353-07:00Blog 4 of 5; We Discover the Source of the CMS 88305 Data: Mesta et al., June 2026!50-word summaryCMS’s July 2026 CY2027 Physician Fee Schedule proposal reproduced striking Maryland data suggesting CPT 88305 may be overvalued -- without naming the source. Discoveries in Health Policy has discovered that the trail leads to Maryland Health Care Commission officials Mesta, Chappel, and Jacobs in Health Affairs. Their open-access article adds useful detail—and Brucehttp://www.blogger.com/profile/05149672650241065616noreply@blogger.com