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TDR Insider

IVD Consolidation Reduces Choices for Labs

TDR Insider / By Robert Michel

Since the launch of The Dark Report in 1995, consolidation of hospitals, physician groups, clinical labs, pathology groups, and IVD manufacturers has been a major trend every year. Today, that consolidation has handed unprecedented economic power to the nation’s two multi-billion-dollar lab corporations and to the IVD manufacturers who sell them automation, analyzers, and tests. …

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Actions Pathologists Can Take to Protect Their Income

TDR Insider / By Robert Michel

Given that pathology reimbursements are always on the chopping block and labor costs are at all-time highs, it’s understandable that anatomic pathologists today feel a threat to their livelihoods. The Panel of National Pathology Leaders is pointing out steps to protect pathologists’ income that include carefully determining fair market value under Medicare Part A contracts …

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

TDR Insider / By Robert Michel

Clinical laboratories may have heard billing code 81408 referred to as “fraudomatic,” and now the Office of Inspector General (OIG) has attached a remarkable number to this problem: $888 million over four years. Payers now have an even greater reason to inspect 81408 claims from genetic testing labs. Reaffirming past reporting here and elsewhere, a …

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

TDR Insider / By 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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Experts Discuss Genetic Test Claim Review

TDR Insider / By Robert Michel

GENETIC TESTING LABORATORIES CAN EXPECT PRIVATE HEALTH INSURERS to require better data about the accuracy and clinical relevance of the genetic test claims being submitted for reimbursement. That was a common message—and prediction—during several presentations at April’s Executive War College in New Orleans. That prediction did not take long to come true. On May 2, …

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UHC’s Z-Code Requirement for Molecular Test Claims Starts Aug. 1

TDR Insider / By Robert Michel

In what may be an alarming development for certain clinical laboratories, as of Aug. 1, UnitedHealthcare will require Z-codes for molecular test claims filed under its commercial health plans. Labs unfamiliar with Z-codes have only a short window of time to register for the codes and collect needed clinical data to support accuracy and utility. …

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Kaiser Acquires Geisinger Health in Blockbuster, Value-Based Deal

TDR Insider / By Robert Michel

The Dark Report examines how the acquisition of Geisinger Health by Kaiser Permanente not only sets the stage for more blockbuster hospital deals, but offers a platform for new value-based reimbursement models. Kaiser is forming a new value-based organization to include Geisinger, which will deliver deliver “value-based quality outcomes and savings in multi-payer, multi-provider environments.” …

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HHS Draft Rule Will Standardize Electronic Signatures

TDR Insider / By Robert Michel

Every year, payers refuse laboratory test claims on grounds that the ordering provider’s signature is missing or illegible—a situation that costs clinical labs million of dollars in missed reimbursements. This situation might change once a proposed rule from the U.S. Department of Health and Human Services is implemented that defines and standardizes physician electronic signatures. …

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Six Important Executive War College Themes to Help Labs Succeed

TDR Insider / By Robert Michel

Clinical laboratories face business challenges with day-to-day operations, genetic testing, and evolving care delivery models. The 2023 Executive War College on Diagnostics, Clinical Laboratory, and Pathology Management returns on April 25-26 in New Orleans. Participants will learn what is changing in the healthcare and lab testing sectors, along with effective responses that can advance their …

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Sanford/Fairview Merger Has Implications for Clinical Labs

TDR Insider / By Robert Michel

Sanford Health in Sioux Falls, South Dakota, and Fairview Health Services in Minneapolis recently announced their intent to merge later this year. The Sanford/Fairview merger, like many blockbuster deals involving integrated delivery networks (IDN), has long-term implications for clinical laboratories. In the new issue of The Dark Report, we explore in detail the motivations behind …

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