Month: July 2013

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July 29, 2013 “Intelligence: Late Breaking Lab News”

Another national health insurance corporation is preparing to institute pre-authorization for genetic tests. Cigna Corporation announced on July 23 that it had selected InformedDNA, to administer its new genetic testing and counseling program. Pathologists and laboratory administrators should note that one goal of Cigna’s new program is “to prevent the ordering of inappropriate genetic tests,” …

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Four Docs Plead Guilty In N.J. Lab Bribery Case

CEO SUMMARY: As of July 24, four New Jersey doctors had pleaded guilty to federal criminal charges. Each of the doctors accepted bribes in exchange for referring patient lab testing to Biodiagnostic Laboratory Services (BLS) of Parsippany, New Jersey. This landmark criminal prosecution includes criminal charges associated with sham lease and service agreements between labs …

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Laboratory Offers Early Lessons in Positioning for Success with ACOs

CEO SUMMARY: Accountable care organizations (ACOs) are already leading the shift from fee-for-service reimbursement to population payment. ACOs are leading healthcare’s evolution to preventive care, wellness, and better management of patients with chronic disease. This evolution will require that all providers, including clinical laboratories, must shift from delivering volume to producing value. In Phoenix, Arizona, …

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Two Omaha Med Centers Form Collaborative Lab

CEO SUMMARY: An accountable care organization with a strong clinical laboratory component is taking shape in Nebraska. The University of Nebraska Medical Center has developed a partnership with the Nebraska Methodist Health System to form an ACO called the Accountable Care Alliance. It will serve Nebraska and perhaps other parts of the Midwest. Both the …

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Feds Nail Doctors for Accepting Bribes from Labs

HALLELUJAH! FOUR DOCTORS IN NEW JERSEY HAVE PLEADED GUILTY to federal criminal charges of accepting bribes from Biodiagnostic Laboratory Services (BLS), the clinical lab company in Parsippany, New Jersey. Can any of you remember the last time that a federal prosecutor pursued criminal felony charges against multiple physicians who were referring lab tests to a …

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Genesis Outreach Lab Acquired by LabCorp

CEO SUMMARY: Sources say that Genesis Clinical Laboratory of Berwyn, Illinois, owned by McNeal Hospital, is being sold to Laboratory Corporation of America. Neither party has publicly acknowledged completion of the sale. It is the latest example of consolidation within the clinical lab industry. It is also another instance of a hospital selling its lab …

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House Bill Introduced to Address Rate-Setting for Molecular Tests

FEW PATHOLOGISTS OR CLINICAL laboratory directors would argue against revising the current Medicare payment policies for molecular and genetic tests. A bill proposed in Congress would do just that. The process now in use by Medicare Administrative Contractors (MACs) is inefficient and opaque, according to pathologists and lab executives. The result is not many clinical …

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Hospital System Acquires Labs In ACO Strategy

CEO SUMMARY: Moving to deliver services as an accountable care organization (ACO), Genesis Health System of Davenport, Iowa, has acquired the laboratory assets in two hospitals previously operated by Metropolitan Medical Laboratory, PLC, a lab company owned by local pathologists. Genesis aims to improve data integration to support CPOE. It also plans to pursue cost …

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BlueCard Policy Causing Clinical Labs to Go Unpaid

CEO SUMMARY: Clinical laboratories doing lab test work for Blue Cross Blue Shield patients using their BlueCard benefit are no longer being paid by the Blues plans. Some Blues plans are sending those reimbursement checks directly to their members with instructions for the patient to use those funds to pay their lab bills. Instead, most …

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Medicare Contractor’s Ruling on MolDx Test Causes Lab to Close

CEO SUMMARY: On May 14, Predictive Biosciences learned that its Medicare contractor had determined that one of its three molecular tests for bladder cancer was a screening test. It also never got a determination on its other two molecular tests. Because Medicare is half of the lab’s payer mix, and since the company was worried …

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