Since 1995, Reliable Business Intelligence for Clinical Laboratories, Pathology Groups and Laboratory Diagnostics
John M. Mattsen, III, MD, one of the founders of ARUP Laboratories of Salt Lake City, died on November 9, at the age of 86. As a pathologist and an executive leader, he was at the forefront of laboratory medicine for many decades. A graduate of Brigham Young University (BS) and UCLA Medical School, Mattsen …
December 16, 2019 Intelligence: Late Breaking Lab News Read More »
CEO SUMMARY: There have been significant developments in the case against Quest Diagnostics for allegedly overcharging uninsured patients for clinical laboratory tests. This second section covers the federal judge’s most recent decisions, along with an assessment of how the plaintiffs and the defendent each received favorable rulings. First of Two Parts: Section Two IN THE …
Judge Issues Split Ruling on Quest’s Motion to Dismiss Read More »
CEO SUMMARY: Court documents filed in U.S. District courts in New Jersey and North Carolina provide details about how each of the two lab companies set lab test prices differently—as much as 10 times higher—for cash-paying patients than for patients who have Medicare, Medicaid, or commercial health insurance plans. In court filings, plaintiffs allege that …
Lawsuits Allege LabCorp, Quest Overcharged Uninsured Patients Read More »
CEO SUMMARY: Laboratory benefit management companies that offer a range of services to health insurers are gaining influence over clinical lab testing in important ways. On behalf of health insurers, LBMs will select labs for a payer’s network, then manage that network. They also manage claims and lab-test utilization, often reviewing medical necessity. A primary …
Lab Benefit Managers Want to Help Health Plans Read More »
CEO SUMMARY: Evidence shows that adoption of ICD-10 diagnosis codes in 2015 made it possible for health insurers to track clinical laboratory testing more closely, ask more questions about those tests, and deny coverage. Increased detail about each patient’s condition has led to increased demands for medical-necessity documentation and to denied payments of as much …
ICD-10 Gives Payers More Data About Lab Claims Read More »
IMPLEMENTATION OF ICD-10 DIAGNOSIS CODESÂ in the United States happened on Oct. 1, 2015. At that time, a national laboratory association predicted that use of ICD-10 codes would cause Medicare Administrative Contractors (MACs) to pay labs less often and with lower reimbursement. The Dark Report agreed with this prediction and published the warnings of the American …
Prediction of ICD-10 as Negative for Labs Comes True Read More »
This is an excerpt of a 1,484-word article in the Nov. 25, 2019 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: It’s an unreported trend tracked only by THE DARK REPORT, but which is essential reading for clinical labs and pathology groups that …
ICD-10 Codes Give Payers More Data About Lab Claims Read More »
On Dec. 19, Congress passed a year-end spending bill that included the Laboratory Access for Beneficiaries (LAB) Act. The bill went to the President for his signature. The bill mandates that the federal Centers or Medicare and Medicaid Services (CMS) delay by one year having labs report their private payer lab test data. This means …
January 6, 2020 Intelligence: Late Breaking Lab News Read More »
John M. Mattsen, III, MD, one of the founders of ARUP Laboratories of Salt Lake City, died on November 9, at the age of 86. As a pathologist and an executive leader, he was at the forefront of laboratory medicine for many decades. A graduate of Brigham Young University (BS) and UCLA Medical School, Mattsen …
December 16, 2019 Intelligence: Late Breaking Lab News Read More »
CEO SUMMARY: Two lawsuits filed in federal courts against Laboratory Corporation of America and Quest Diagnostics may have consequences for the entire lab industry. The plaintiffs are patients who allege that the two defendant lab companies charged them as much as 10 times more than what Medicare, Medicaid, or commercial health plans charged. Allegations include overcharging, …
Lawsuits Alleging Overcharges to Proceed in Two Courts in 2020 Read More »
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