January 2017

NJ Lab Sues to Challenge Payers About Its Out-of-Network Status

ONE WAY THAT A CLINICAL LAB can fight back against insurers who refuse to pay lab test claims is to sue them. That’s exactly what Medical Diagnostic Laboratories of Hamilton, N.J. is doing! Not only has MDL filed lawsuits against two major health insurance companies, but in one lawsuit, it named a national lab company […]

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In Texas, Questions for UnitedHealth, BeaconLBS

Clinical Laboratory Trends / Joseph Burns

CEO SUMMARY: As of January 1, 2017, clinical laboratories and pathology groups in Texas will find it more difficult to serve the 500,000 patients enrolled in UnitedHealthcare’s fully-insured commercial plans in the Lone Star State. That’s because—just as it did in Florida—UnitedHealthcare, with its partners BeaconLBS and Laboratory Corporation of America, is implementing its laboratory

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Theranos Lays Off More Staff, Voids More Lab Test Results

Clinical Laboratory / Joseph Burns

ONCE AGAIN, the controversial lab testing company, Theranos, Inc., found itself the subject of negative news stories. In recent weeks, The Wall Street Journal reported that the beleaguered lab testing company in Palo Alto, Calif., laid off 155 staffers, voided more laboratory test results, and cut ties with its high-profile lawyer. This round of bad

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Is Pharmacogenomics Testing Unaffordable for Payers?

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

ACROSS THE UNITED STATES, labs that perform pharmacogenomic tests complain that both government and private payers are reluctant to issue coverage guidelines and adequate reimbursement for these assays. Yet, this new class of diagnostic lab tests is the foundation of personalized and precision medicine. Why are government and private health programs taking this tough stand

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Pharmacogenomic Testing Draws $26 Million Recoupment from Medicare Audit

TDR Insider / Mary Van Doren

This is an excerpt from a 1,340-word article in the January 9 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: Pharmacogenomic testing is expected to be a linchpin to the practice of

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PAMA Economics Drives Merger Of Two Seattle-Area Pathology Groups

Pathology Trends / Joseph Burns

CEO SUMMARY: Among the three chief reasons for the merger of CellNetix and Puget Sound Institute of Pathology, the most compelling was the need to address the challenges in the current reimbursement environment and to prepare for reductions in payment to pathologists expected in the coming years under the Patient Access to Medicare Act. CellNetix

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$26 Million Recoupment from Medicare Audit Hammers Pharmacogenomic Lab

Laboratory Billing / Joseph Burns

CEO SUMMARY: After Pharmacogenetics Diagnostic Laboratory LLC was audited by a Medicare Zone Program Integrity Contractor (ZPIC), it faced a $26 million repayment demand. The lab company appealed and asked for a redetermination, then filed for Chapter 11 bankruptcy protection. These developments should be a concern to all labs offering pharmacogenomic testing to Medicare patients.

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