Discoveries in Health Policy

Can AI Get PAMA News From Investor Calls?

2026-09-16T08:20:09.663-07:00

I asked both CLAUDE and CHAT GPT to scan recent lab industry investor calls for PAMA news and predictions. I include CLAUDE below; the two were similar. I include a cloud link to Chat GPT here.This is direct AI output, offered as-is, I have not checked against original transcripts or audio files.##CLAUDE Opus##Please research public calls like investor calls for Carius,

Very Brief Blog; Convergent Genomics Exits via Veracyte Acquisition

2026-09-16T08:03:51.317-07:00

https://www.genomeweb.com/diagnostics/molecular/liquid-biopsy/gnw-veracyte-acquisition-convergent-genomics-20260915/Here is the headline news:NEW YORK – Veracyte said after the close of the market Monday that it has acquired Convergent Genomics, which has developed a urine-based DNA testing platform for cancer diagnostics.The acquisition includes $150 million in upfront cash and up to $30

Watchdog Releases Documentation of WISER Prior Auth Problems; How to Upgrade FOIA to Lawsuit

2026-09-16T07:36:30.499-07:00

The watchdog EFF Electronic Frontier Foundation has released 1000 pages of CMS documents, which in part lay out problems with launcher WiSER, Medicare's attempt to bring Ai and Prior Auth together into the rickety fee for service claims processing system.There are a number of open access news stories, and you can link directly to the "treasure trove" of FOIA documents. One tip - they didn't

Very Brief Blog: CMS Updates NCD Wait List

2026-09-16T07:18:55.629-07:00

CMS has provided a September 2026 update of its "wait list" for future NCDs. CMS also flags recently completed NCDs.Find it here:https://www.cms.gov/files/document/ncddashboard.pdf

Genomeweb: Alarm Over CMS Rule on Lab Algorithms

2026-09-13T16:10:34.832-07:00

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

Do Current Fraud Press Releases Flag the Pending CRUSH Regulation?

2026-09-13T15:20:35.538-07:00

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

The Evergreen HHS Press Release: Recyling Rural Health Investment News

2026-09-13T15:15:49.809-07:00

Header: 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

AMA CPT Asks Weird Social Equity Questions; RFK Jr Goes on Attack

2026-09-10T05:40:50.698-07:00

It'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

You Better Learn the Biggest Myth About Payor Coverage of Diagnostics

2026-09-09T15:01:06.824-07:00

"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

AI Corner: The strange path to remote monitoring coding, and the latest twist

2026-09-09T14:45:26.526-07:00

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 subject

AI Guest Author: A New Report on Better External Control Arms via N-Power Medicine Series B

2026-09-07T12:44:29.890-07:00

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

Humor: From Cocktail Napkin Scribble to Sophisticated Diagram

2026-09-06T11:11:40.360-07:00

Last 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.

AMA Lab Code Application Revisions are Large and Important

2026-09-06T09:02:26.946-07:00

Header: 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

AMA's Appendix S: Don't Incorporate Into Code Decisions Until it is Fixed

2026-09-06T08:14:34.018-07:00

Header: 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

Humor: Sorry We Have No Design Suggestions

2026-09-03T15:28:31.130-07:00

Sorry, We have No Design Suggestions For This Slide.(click to enlarge)

FDA is Really Doing It: Downclassify CDx based on ISH-FISH (August 2026)

2026-09-03T08:22:43.957-07:00

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

MolDx Issues Bonanza of New LCDs in Late August 2026

2026-09-03T07:59:55.250-07:00

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

MolDX MACs Delay Finalization of Prelude DCISion-RT LCD

2026-09-02T15:50:09.672-07:00

MolDx 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

OPPS Rule: Ditching Digital Pathology from CLFS and CLIA? Stakeholder Organizations Comment

2026-09-02T10:23:29.467-07:00

(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 AMA

Is Digital Pathology Close to the BIllion-Dollar Explosion in Value?

2026-09-01T09:49:10.169-07:00

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

You've Never Seen This: The CMS Digital Pathology Rule as Exciting "Harvard Case Study"

2026-08-30T14:27:45.107-07:00

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 up

Piling on to Software as a service; MEDPAC Plans

2026-08-26T18:58:28.290-07:00

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 specifically

Revisited: CAP and CMS Go in Opposite Directions on Digital Pathology

2026-08-26T13:00:09.103-07:00

In 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

Very Brief Blog: CMS OPPS CY2027 Comment Due Aug 31

2026-08-26T10:47:32.516-07:00

There 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 "

AI Reviews: ADAPT OR BECOME IRRELEVANT - Alternative Visions for Pathology

2026-08-26T10:29:45.681-07:00

You 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