Issue: Volume XXVI No. 6 - April 29, 2019

“I’m from the Government, and I’m here to help.”

Across the nation, clinical laboratories struggle to correctly interpret and follow the new National Correct Coding Initiative (NCCI) guidelines that took effect on Jan. 1. A financial disaster lies ahead for many labs. “The denials are very high right now and those denials are nationwide,” stated Kyle Fetter, Executive Vice President and General Manager of …

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UHC Sets July 1 Launch for New Preferred Network

CEO SUMMARY: UnitedHealthcare will launch a new preferred laboratory network with seven lab companies on July 1. In an April 22 announcement, UHC said physicians and consumers may continue to use its existing network of more than 300 labs currently in-network. One goal is to give patients a choice of labs based on price with …

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Labs Get High Denial Rates Under New NCCI Rules

CEO SUMMARY: Under guidelines the National Correct Coding Initiative issued last year, many clinical laboratories are not getting paid for some tests. The rates of denial for labs running mostly molecular tests could range from 40% to 100% of revenue, one billing expert said. Implemented Jan. 1, the guidelines apply to labs running tests in …

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ACLA: NCCI Guidelines Are a ‘Step Backwards’

CEO SUMMARY: In a letter to the National Correct Coding Initiative, the American Clinical Laboratory Association (ACLA) raised significant concerns about new language in the policy manuals for Medicare and Medicaid. ACLA said the new NCCI guidelines for molecular and other tests requiring multiple steps for one specimen reduce transparency, increase the administrative burden on …

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PAMA Price Cuts Now Delivering One-Two Punch to Labs’ Revenue

WHEN DISCUSSING THEIR EARNINGS with Wall Street analysts in February, executives from both Laboratory Corporation of America (LabCorp) and Quest Diagnostics explained that the lab test price cuts from the Protecting Access to Medicare Act of 2014 (PAMA) were not only reducing revenue, but that many state Medicaid plans are following Medicare’s lead and cutting their …

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Improve Your AP Group’s Financial Performance

CEO SUMMARY: Across the nation, health insurers are paying less for anatomic pathology services. This shrinks pathology group revenue and reduces pathologist compensation. Savvy pathology groups are responding to this trend by reviewing long-standing processes in their coding, billing, and collections department. Their goal is to update these billing and collections processes in ways that …

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April 29, 2019 Intelligence: Late Breaking Lab News

Investor interest in digital pathology (DP) and the use of artificial intelligence (AI) to analyze digital pathology images seems to be at a fever pitch recently. In the last three weeks, investors poured almost $85 million of capital into just three digital pathology companies, as noted below. This activity may be a sign that certain DP …

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