Since 1995, Reliable Business Intelligence for Clinical Laboratories, Pathology Groups and Laboratory Diagnostics

Month: December 2007

Using a 1997 Bid Model In a 2007 Health Market

The Dark Report / By Robert Michel

CEO SUMMARY: It’s been a long path from concept to implementation for a competitive bidding demonstration involving clinical lab services. It was in the mid-1980s when CMS commenced work on designing such a demonstration. In the 1990s, RTI International continued development of the concept and, in 1998, it published a paper on the plan it …

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December 31, 2007 “Intelligence: Late Breaking Lab News”

Late Breaking Lab News / By Robert Michel

There’s late-breaking news affecting new federal rules for the anti-markup provisions scheduled to become effective on January 1, 2008. Just days ago, the federal Centers for Medicare & Medicaid Services (CMS) issued a final rule that generally delays, until January 1, 2009, some of the anti-markup provisions in the 2008 Medicare physician fee schedule which were to …

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Call to Action Is Needed For Lab Test Profession

The Dark Report / By Robert Michel

CEO SUMMARY: Is a laboratory test simply a commodity, like wheat or coal? Or is it a complex scientific service of unique value that delivers personalized results and clinical knowledge on behalf of millions of patients every day in the United States? The fundamental assumption of competitive bidding for clinical laboratory testing is that one …

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Three Strikes Against CMS Before Bid Demo Begins

The Dark Report / By Robert Michel

CEO SUMMARY: There’s a touch of irony in the fact that the Medicare program is a national leader in encouraging hospitals, physicians, and other providers to pay greater attention to the voice of patients. Yet within the Centers for Medicare & Medicaid Services (CMS), officials tasked with developing the laboratory competitive demonstration project seem to …

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Speculating On How Labs Might Respond to Demo

The Dark Report / By Robert Michel

CEO SUMMARY: Statements and actions by CMS officials responsible for the laboratory competitive bidding demonstration project reveal the likelihood that they are using it as a Trojan Horse. While talking about implementation of a three-year demonstration project in the San Diego MSA, CMS dropped hints that it will use the bids submitted on February 15 …

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Numerous Issues Identified With Bid Demo’s 303 Tests

The Dark Report / By Robert Michel

CEO SUMMARY: One experienced expert in billing and coding was surprised at the list of 303 tests to be included in the Medicare Laboratory Competitive Bidding Demonstration Project. He notes that the list of 303 tests includes a number of codes and descriptions that are not consistent with CPT codes used by laboratories to prepare …

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Is CMS Playing “Bait and Switch” in San Diego?

Commentary and Opinion by R. Lewis Dark / By R. Lewis Dark

ATTEMPTING TO WRITE THE ASSESSMENT of the Medicare Clinical Lab Services Competitive Demonstration Project that you will read in this issue earned a unique distinction: since our founding in 1995, this has been the single most difficult story we have ever tried to explain to our clients and regular readers. At the same time, it is …

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San Diego Bid Demo Pilot Is Industry Turning Point

The Dark Report / By Robert Michel

CEO SUMMARY: In just six weeks, laboratories serving Medicare patients in the San Diego-Carlsbad-San Marcos MSA (metropolitan statistical area) will submit their bids to the Centers for Medicare & Medicaid Services (CMS). They may think they are bidding for access to patients in the San Diego MSA for the three-year duration of the demonstration pilot. …

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Analyzing Lab Bid Demo To Predict Its Outcome

The Dark Report / By Robert Michel

CEO SUMMARY: After two decades of study and preparation, the Centers for Medicare & Medicaid Services (CMS) is pushing the laboratory profession toward the first pilot site in the Congressionally-mandated Medicare Clinical Laboratory Services Competitive Demonstration Project. Designed to drive down the price Medicare pays for laboratory tests, the plan CMS described at the December …

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Anticipate Access/Service Decline for S.D. Patients

The Dark Report / By Robert Michel

CEO SUMMARY: In its primary push to use the Medicare Laboratory Competitive Bidding Demonstration Project as a tool to drive down the price Medicare pays for Part B laboratory testing services, CMS is giving secondary attention to patients’ needs. In particular, CMS seems to place little value on the multi-year relationship and loyalty many elderly …

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