July 2023

‘Virchow’ Is Your New Source of Managed Care Insights

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

WE ARE UNVEILING A VALUABLE INTELLIGENCE RESOURCE FOR YOU. It is a new commentary focused exclusively on managed care contracting for diagnostic services provided by clinical laboratories and anatomic pathology groups. We named it “Virchow” in recognition of Rudolf Virchow (1821-1905), the famed German physician who shaped modern pathology and laboratory medicine. Lab leaders need […]

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OIG: Billing Code 81408 Is at ‘Risk of Improper Payment’

Genetic Testing, Lab Risk & Compliance, Laboratory Billing, Laboratory Compliance, Molecular Diagnostics / Scott Wallask

CEO SUMMARY: Clinical lab executives familiar with molecular test coding and billing will not be surprised to learn that billing code 81408—commonly used on genetic test claims—is at risk of fraudulent Medicare payments. A new report from the Office of Inspector General attaches a remarkable number to this threat: $888 million over four years. Payers

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Digital Pathology Rollout Was ‘Big Bang’ at University of Louisville

Anatomic Pathology, Digital Pathology, Lab Intelligence, Laboratory Equipment / Scott Wallask

CEO SUMMARY: It took less than one year to achieve full implementation of whole slide imaging and digital pathology at the University of Louisville’s Department of Pathology. One decision was to scan slides in a central location to promote efficient workflows. Integrating digital pathology with the pathology LIS and artificial intelligence software proved to be

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2022 Ranking of the World’s Top 12 IVD Corporations

In Vitro Diagnostics, IVD/Lab Informatics, Lab Marketplace / Scott Wallask

WHILE THE TOP FOUR IN VITRO DIAGNOSTICS (IVD) MANUFACTURERS kept their collective hold on the market compared to 2021, the big surprise was that Thermo Fisher Scientific’s Lab Products Division jumped up two positions to become the largest global IVD corporation, based on The Dark Report’s 2022 ranking of the Top 12 IVD Companies. (See

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Hospital Lab Outreach Selloffs Continue with Labcorp as Buyer

Clinical Laboratory Trends, Lab Marketplace, Laboratory Management / Scott Wallask

OVER THE LAST FEW MONTHS, Labcorp has shaken up the hospital laboratory market in the Pacific Northwest, particularly as it concerns lab outreach services. On July 11, the Burlington, North Carolina-based company announced a deal with nonprofit Legacy Health, a six-hospital health system in Portland, Oregon. Under the arrangement, Labcorp will acquire select assets of

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With Z-codes, Will Other Payers Follow UnitedHealthcare’s Lead?

Genetic Testing, Lab Intelligence, Laboratory Billing, Managed Care Contracts, Molecular Diagnostics / Virchow

EDITOR’S NOTE: Our new column, Virchow, is written by anonymous insiders working within the managed care world. The column aims to help clients of The Dark Report better understand the decisions, policies, and actions of payers as they manage their laboratory networks, establish coverage guidelines, process lab test claims, and audit labs. Genetic testing laboratories

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Competency Assessments Prove To Be a Nagging CLIA Deficiency

Laboratory Compliance, Laboratory Management, People / Scott Wallask

CEO SUMMARY: Competency assessment problems rank high among frequently cited deficiencies during CLIA inspections. Representatives from the CAP, COLA, and The Joint Commission explain what areas to watch out for and how to avoid citations. Among the hotspots: ensuring technical consultants and technical supervisors are qualified. Editor’s note: This is the first installment in an

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July 31, 2023, Intelligence: Late-Breaking Lab News

Late Breaking Lab News / Scott Wallask

Regulatory relief is on the way for clinical laboratories accredited by The Joint Commission. An overhaul of the Laboratory Accreditation Program’s standards, which goes into effect Aug. 27, will reduce the number of Elements of Performance (EPs) under the lab standards. A review of the changes shows that 79 EPs have either been revised or

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UHC Z-code Deadline Looms, Raising Concerns About Technical Assessment Timelines

TDR Insider / Scott Wallask

By now, many of you are aware that UnitedHealthcare is scheduled to begin requiring Z-codes for genetic test claims under its private health plans. That Aug. 1 deadline raises questions about whether labs that need to complete a technical assessment as part of their Z-code requests will have enough time for a review. Experts weigh

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July 10, 2023, Intelligence: Late-Breaking Lab News

Late Breaking Lab News / Scott Wallask

General health panels submitted under CPT code 80050 are among the most expensive—and potentially most wasteful—diagnostic tests, according to a new study published in June by Avalon Healthcare Solutions in Tampa, Florida. These panels include a metabolic panel, complete blood count, and thyroid stimulating hormone level. Avalon reported that 80050 is likely a prime example of “panel

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