From the Volume XXVII No. 1 – January 6, 2020 issue
TYPICALLY, PEOPLE CELEBRATE THE ARRIVAL OF A NEW YEAR and a new decade with optimism. That should be just as true for clinical lab managers and pathologists. After all, medical laboratory testing is fundamental to how physicians diagnose disease, select the most appropriate therapies, and monitor the progress of their patients.
Yet events of recent years have
From the Volume XXVI No. 17 – December 16, 2019 issue
Is it a coincidence that a number of uninsured consumers filed separate lawsuits in federal courts against Laboratory Corporation of America and Quest Diagnostics—alleging, in both cases, that they were overcharged for clinical laboratory tests—just months before the federal government published final rules requiring hospitals and other providers to publish their prices?
Last month, the federal Centers
From the Volume XXVI No. 16 – November 25, 2019 issue
IMPLEMENTATION OF ICD-10 DIAGNOSIS CODES 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 Clinical
From the Volume XXVI No. 15 – November 4, 2019 issue
THERE IS AN OFT-REPEATED ADAGE THAT what the government gives you with one hand, it takes away with the other. This may be an apt description of the new Medicare final rule that takes effect today, called the Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC).
The goal of the new rule is to give
From the Volume XXVI No. 14 – October 14, 2019 issue
IS IT A COINCIDENCE THAT, IN THIS ISSUE OF THE DARK REPORT, we cover two related developments, both involving the federal government’s efforts to control healthcare fraud and abuse?
First, you’ll read about the new federal rule scheduled to take effect on Nov. 4. It gives federal healthcare investigators new powers to exclude individuals and organizations
From the Volume XXVI No. 13 – September 23, 2019 issue
IT’S CALLED THE OPIOD CRISIS AND IT’S OFTEN A MAJOR STORY in the nightly news. In 2017, deaths from drug overdoses totaled 70,237, of which 68% (47,600) were opioid overdose deaths, according to the federal Centers for Disease Control and Prevention.
Across the nation, government health officials and healthcare providers struggle to address the problems of opioid
From the Volume XXVI No. 12 – September 3, 2019 issue
IT MAY NOT BE A COINCIDENCE THAT MANY RECENT NEWS CYCLES have more negative pathology news than positive pathology news. After all, laboratory medicine is at the core of most clinical care delivered to patients, so it’s no coincidence that pathology—both clinical and anatomic—is a prime target for government and private payers, along with federal investigators.
The
From the Volume XXVI No. 11 – August 12, 2019 issue
ONCE AGAIN, A HIGH-PROFILE LAB COMPANY faces allegations of fraud and abuse. This time it is True Health Diagnostics of Frisco, Texas. Details of this case were revealed last month when True Health filed a lawsuit in a federal court in Texas against the agencies running the federal Medicare program.
In its lawsuit, True Health denies
From the Volume XXVI No. 10 – July 22, 2019 issue
Due to medical errors, three patients died in three Houston hospitals in a short period of time. Each adverse event led to inspections by the federal Centers for Medicare and Medicaid Services (CMS) and sanctions as tough as revocation of deemed status for participation in the Medicare program.
That these events came so closely together, at
From the Volume XXVI No. 9 – July 1, 2019 issue
TWO OF THE NATION’S LARGER HEALTH INSURERS—AETNA AND ANTHEM— ARE CUTTING WHAT THEY PAY for the professional component of certain clinical and anatomic pathology codes.
In its communications with pathology groups about this policy change, Aetna says it will no longer pay for most clinical laboratory claims submitted with the modifier 26 for professional component services.
