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Volume XXVI No. 9 - July 1, 2019

Aetna, Anthem to Pay Pathology Groups Less

Commentary and Opinion by R. Lewis Dark /

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 […]

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Anthem Rolling Out More Anatomic Path Price Cuts

Laboratory Billing /

CEO SUMMARY: Anthem is making big changes to its relationships with anatomic pathology groups. Getting most of the attention at the moment are the insurer’s letters announcing price cuts for anatomic pathology services of 50% to 70% of Medicare fees. But another major change may also trigger negative consequences for pathologists. Anthem is moving pathology

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Aetna Ends Payment for Professional Component

Laboratory Billing /

CEO SUMMARY: As of Aug. 1, Aetna will stop paying out-of-network pathologists for the professional component review of certain clinical pathology tests. Until now, the health insurer has paid for the professional component when out-of-network labs billed for clinical lab tests using the modifier 26. In a notice to labs, Aetna said it will pay

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Four Insurers, Quest Developing Blockchain

Clinical Laboratory Trends /

CEO SUMMARY: Organizations developing blockchain technology say it is a tamper-proof method of sharing data across networks and among providers, health insurers, and health systems. The Synaptic Health Alliance includes four of the largest health insurers, a health network, and Quest Diagnostics. Its first project, now in its second year, will use blockchain to create

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Labs Should Heed Lessons from Huge Data Breach

Laboratory Information Systems /

CEO SUMMARY: Following news last month about the biggest breach of personal health information in the clinical lab industry, lawyers representing some of the affected patients filed at least 12 class action lawsuits. Federal officials and attorneys general in multiple states also launched investigations. The breach occurred when hackers gained access to the data systems

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AP Practices Cautioned to Focus on Expenses

Laboratory Management /

CEO SUMMARY: Reviewing an AP practice’s expenses is vitally important today when payers are cutting reimbursement. In the past, government and private payers paid more for the technical and professional components of anatomic pathology work, but those rates have eroded. While conversations about revenue tend to obscure the need to talk about expenses, effective financial

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July 1, 2019 Intelligence: Late Breaking Lab News

Late Breaking Lab News /

In Houston, news outlets report that MD Anderson Cancer Center was cited for serious deficiencies and the potential for patient harm, following inspections by officials from the federal Centers for Medicare and Medicaid Services (CMS) and the Texas Department of State Health Services. After an adverse patient event involving transfusion services that occurred in December,

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Anthem Rolling Out New Pathology CPT Code Cuts

TDR Insider /

This is a synopsis of a 2,120-word article in the July 1, 2019 issue of THE DARK REPORT (TDR). The full articles are available to members of The Dark Intelligence Group.  CEO SUMMARY: Anthem is making big changes to its relationships with anatomic pathology (AP) groups. Getting most of the attention at the moment are

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