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November 2016

Expert Explains Why Payer Errors Skew Labs’ PAMA Price Data

Laboratory Billing / By Joseph Burns

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 sources of problems in the …

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November 28, 2016 Intelligence: Late Breaking Lab News

Late Breaking Lab News / By Robert Michel

In recent weeks, two different lab transactions were announced. One involved a hospital laboratory management contract and the other was a potential merger of two anatomic pathology lab companies. The first announcement came on October 31, when Lovelace Health System of Albuquerque, New Mexico, released news that it entered into an “inpatient and outpatient laboratory …

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Labs Discover Much Complexity In Their Lab Test Price Data

Laboratory Billing / By Joseph Burns

DON’T EXPECT IT TO BE EASY AND STRAIGHTFORWARD when reporting the prices of chemistry panels as the final rule for lab test market price reporting rule requires. Instead, labs should expect the process to be complex and troublesome. Also, labs should be concerned that Medicare officials have threatened to make deep cuts to chemistry panel …

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Will Coming Medicare Fee Cuts Reduce Access to Laboratory Tests?

Clinical Laboratory / By Joseph Burns

SEVERAL IMPORTANT clinical laboratory associations are concerned that the lab test price reporting under the Patient Access to Medicare Act of 2014 will have a negative effect on diagnostic innovation and on Medicare beneficiaries’ access to lab testing services. The American Clinical Laboratory Association wants to ensure that the new Medicare Part B clinical laboratory …

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Widespread payer errors will cause headaches as Protecting Access to Medicare Act of 2014 price reporting comes due

TDR Insider / By Mary Van Doren

This is an excerpt from a 2,700-word article in the November 28 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: THE DARK REPORT delivers the most detailed explanation ever offered of the …

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OIG Comments on PAMA Plan and Exclusion of Many Labs from Reporting

Laboratory Billing / By Joseph Burns

ON THE SUBJECT OF LAB TEST MARKET PRICE REPORTING as required under PAMA, many clinical laboratory executives, pathologists, and industry experts see deep flaws in the process the federal Centers for Medicare & Medicaid Services has established. Yet, CMS itself seems blind to these flaws. Fortunately, the clinical lab executives are not alone. The Office …

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California’s Lab Price Data Collection Project Cuts Lab Test Prices by 10.5%

Laboratory Billing / By Joseph Burns

COLLECTING LAB TEST PRICE DATA is not limited to PAMA and the federal Centers for Medicare & Medicaid Services. California’s Medi-Cal program is in its second year of requiring clinical labs to submit private payer lab test price data. However, in both the first and second year of requiring clinical labs to report lab test …

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Should Labs File Court Challenge To PAMA Price Report Rule?

Laboratory Billing / By Robert Michel

CEO SUMMARY: Just four weeks remain before CMS begins collecting private payer clinical laboratory test price data. Many lab industry executives have charged that Medicare officials are not following the language of the PAMA statute or the intent of Congress. At stake are $5.4 billion in Part B fee cuts that CMS plans to introduce. …

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Could Community Labs Become Extinct after PAMA?

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

IN THE PURSUIT OF IMMEDIATE COST SAVINGS, our federal government may be about to tinker with an essential clinical service in ways that will severely harm patients in rural areas and small towns throughout the United States. Specifically, will the final rule to implement PAMA lab test market price reporting turn out to be a …

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Why Small Labs and Even Hospitals Are at Risk from PAMA Cuts

Clinical Laboratory / By Robert Michel

CEO SUMMARY: Clinical lab executives and experts who have studied the final rule for PAMA lab test market price reporting are seriously concerned that the design of this rule may put many of the nation’s smallest, but still essential, clinical labs at great risk of financial distress, if not outright failure. In this exclusive analysis, …

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