lab fees Archives

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lab fees

NILA: CLIA Proposal Doesn’t Address Flaws

By Joseph Burns | From the Volume XXV No. 3 – February 12, 2018 Issue

CEO SUMMARY: For many years, NILA has urged the federal Centers for Medicare and Medicaid Services to make significant changes in CLIA regulations. Yet, in its recent request for information, CMS addressed five specific areas. But the federal agency left out the need for a comprehensive o…

Time’s running out to stop Medicare lab fee schedule cuts

By Mary Van Doren | From the Volume XXIV No. 11 – August 7, 2017 Issue

This is an excerpt from an article in the August 7, 2017 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group. CEO SUMMARY: Only a few mo…

UHC, LabCorp Play Hard Ball With Texas Lab Contracts

By Joseph Burns | From the Volume XXIII, No. 17 – December 19, 2016 Issue

CEO SUMMARY: In launching BeaconLBS in Texas, UnitedHealthcare included a new, more onerous twist than it used for BeaconLBS in Florida. To be a BeaconLBS in-network ‘lab of choice,’ a lab must be in the lowest quartile for lab test prices. Any lab above the 25th percentile would have…

Expert Explains Why Payer Errors Skew Labs’ PAMA Price Data

By Joseph Burns | From the Volume XXIII No. 16 – November 28, 2016 Issue

CEO SUMMARY: In its work with more than 200 lab clients, XIFIN, Inc., of San Diego, sees the best and worst of problems in how labs submit claims to lab tests and how payers process these claims. In this exclusive interview, Lâle White, XIFIN’s Founder and CEO, identifies the systemic …

New ADLT Payment Rate May Force Lab to Close

By Joseph Burns | From the Volume XXII No. 15 – October 26, 2015 Issue

CEO SUMMARY: Four Medicare Administrative Contractors currently pay $2,821 for CareDx’s AlloMap test. But under the proposal that CMS issued last month to overhaul the clinical lab fee schedule, CareDx would get only $644. Such a steep price cut would put the lab out of business because…

Labs Have Questions for CMS on Proposed Rule

By Joseph Burns | From the Volume XXII No. 14 – October 5, 2015 Issue

CEO SUMMARY: On September 25, CMS took a long overdue step to issue a proposed rule on how medical laboratories are to report private market prices for lab tests to the Medicare program during 2016. The proposed rule provides insights as to how CMS envisions pricing new tests and advanced…

Beware Ides of March! Lawmakers Are in Session

By Joseph Burns | From the Volume XXII No. 4 – March 9, 2015 Issue

CEO SUMMARY: Few pathologists and lab administrators know that, when the Protecting Access to Medicare Act of 2014 (PAMA) became law last April 1, language in the bill was scored to reduce Part B clinical laboratory test fees by $2.5 billion over 10 years. Congress used those lab…

FL Docs Say: ‘No Thanks’ to UHC and BeaconLBS

By Joseph Burns | From the Volume XXI No. 14 – October 13, 2014 Issue

CEO SUMMARY: Some Florida physicians are declaring their intent to leave UnitedHealthcare’s network because they find the insurer’s new BeaconLBS laboratory benefit management system to be time consuming and onerous. The defections come as the program goes through a soft launch that b…

Florida Doctor Questions Lab Test Pre-notification

By Joseph Burns | From the Volume XXI No. 12 – September 2, 2014 Issue

CEO SUMMARY: An interesting tug-of-war may develop in Florida between a major health insurer and physicians. UnitedHealthcare will require physicians to obtain a pre-notification number for 81 lab tests by using the BeaconLBS system (developed by a subsidiary of LabCorp). One family pract…

PAMA’s New Rules Affect Lab Test Pricing, Coverage

By Joseph Burns | From the Volume XXI No. 8 – June 9, 2014 Issue

CEO SUMMARY: For several reasons, the “Protecting Access to Medicare Act” (PAMA) has the potential to be the most disruptive federal legislation directed at the clinical lab industry since the enactment of CLIA 1988. Following passage of the law, some lab industry groups have taken di…

Volume XXXI, No. 5 – April 8, 2024

The fragmentation of consumer markets is reflected in clinical lab services, and The Dark Report examines this trend and how it will impact labs in the coming years. Also, The Dark Report notes that the FDA has issued a controversial memo to reclassify many high-risk IVD assays.

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