Issue: Volume XX No. 5 - April 15, 2013

Reimbursement System Fails Labs and Patients

There is confusion and disruption in the molecular testing sector of the clinical lab testing industry. That’s because both government and private payers were not ready to process and reimburse for the 100+ new molecular CPT test codes on January 1, 2013. That is the date when the Medicare program was supposed to be ready …

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Payers Bolix MDx Codes, Labs Unpaid for Months

CEO SUMMARY: Clinical laboratories complain that implementation of a new payment system for molecular tests has been a disaster since January 1. Most contractors for the federal Centers for Medicare & Medicaid Services have not paid labs for molecular tests billed this year. Billing experts indicate that many commercial plans are not paying either. Groups …

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How CMS ‘Mismanaged’ Pricing of Molecular Tests

CEO SUMMARY: CMS and its contractors had ample opportunity to implement a new reimbursement system but failed to act in a timely manner, stated an expert familiar with the problem. The result is that laboratories, particularly those that have one or two proprietary molecular tests, are being harmed needlessly, he said. Without regular payments for …

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Medicare Taken to Task about Molecular Test Pricing Method

EDITOR’S NOTE: Submitted by Lâle White, CEO of XIFIN, Inc., of Carlsbad, California, this letter describes the problems caused by the Medicare program’s failure, as of January 1, 2013, to be ready to process and reimburse lab test claims for more than 100 new molecular diagnostic CPT codes. Dear Editor: Everyone should read Scott Gottlieb, …

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Palmetto: ‘We Are Processing & Paying Clean Claims without Undue Delay’

SEEING THAT PALMETTO, GBA, the nation’s largest Medicare Administration Contractor, seems to be at the center of the controversy over how Medicare is to pay for molecular pathology (MoPath) tests, THE DARK REPORT sent a list of questions to Palmetto Vice President Mike Barlow. Here are the questions and his answers. Q: Is it true …

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Experts Say Labs May Start to Receive MDx Payments

CEO SUMMARY: In the fourth month of the current year, there is plenty of confusion and uncertainty over how the Medicare program will establish prices for the new molecular CPT codes and when both government and private payers will begin to regularly reimburse laboratories. As of this date, even lab billing experts and lawyers are …

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Dark Daily

April 15, 2013 “Intelligence: Late Breaking Lab News”

Geisinger Health System broke ground last month on construction of a new $52 million medical laboratory facility. It will be 115,000 square feet and will be located at the site of the Geisinger Medical Center in Danville, Pennsylvania. LAB COMPANY COMPLETES IPO Cancer Genetics, Inc., of Rutherford, New Jersey, completed an initial public offering (IPO) …

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