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Value-based healthcare launches new conflicting interests for hospital labs, independents
By Mary Van Doren | From the Volume XXIV No. 16 – November 20, 2017 Issue
This is an excerpt from a 2,400-word article in the Nov. 20, 2017 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group. CEO SUMMARY: Her…
Lab Scheme Recruits Hospitals To Bill as In-Network Providers
By Joseph Burns | From the Volume XXIV No. 15 – October 30, 2017 Issue
CEO SUMMARY: Management companies using a new generation of potentially fraudulent schemes are targeting hospitals and health systems for arrangements that use questionable means to increase lab test volume and revenue. The management companies often use the term “hospital outpatient de…
New source of lab test abuse surfaces in the form of HOPDs and MSOs
By Mary Van Doren | From the Volume XXIV No. 15 – October 30, 2017 Issue
This is an excerpt from a 2,350-word article in the Oct. 30, 2017 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group. CEO SUMMARY: …
XIFIN CEO White Analyzes Medicare 2018 Fee Cuts
By R. Lewis Dark | From the Volume XXIV No. 14 – October 9, 2017 Issue
CEO SUMMARY: If the draft lab rates that CMS published Sept. 22 for the Clinical Laboratory Fee Schedule for 2018 go into effect Jan. 1 as proposed, then clinical labs will see a cut of 28% in what they get paid for the top 20 most common tests, according to a recent analysis. The rates t…
Drug Testing Labs in Texas, California Deal With Fraud Charges
By Joseph Burns | From the Volume XXIV No. 13 – September 18, 2017 Issue
CEO SUMMARY: Two toxicology lab companies accused of fraud are fighting to stay in business. In the case of Medicus Laboratories of Dallas, it is asking a federal judge to issue a temporary restraining order to prevent state and federal lab regulators from pulling its CLIA license. At Pro…
Proove Biosciences, Medicus Face Serious Fraud Charges
By Mary Van Doren | From the Volume XXIV No. 13 – September 18, 2017 Issue
This is an excerpt from a 1,400-word article in the Sept. 18, 2017 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group. …
UnitedHealth to Start Gene Test Pre-Approval
By Joseph Burns | From the Volume XXIV No. 12 – August 28, 2017 Issue
CEO SUMMARY: With programs now at the nation’s two largest insurers, is it possible to argue that prior-authorization is going mainstream? Some observers say, yes, as THE DARK REPORT predicted. What is certain is that starting Nov. 1, UnitedHealthcare is requiring prior authorization fo…
Two Largest Payers Start Lab Test Pre-Authorization
By Joseph Burns | From the Volume XXIV No. 12 – August 28, 2017 Issue
CEO SUMMARY: Once Anthem and UnitedHealthcare establish their respective genetic test prior-authorization programs, a new era for genetic testing will commence. The 80 million beneficiaries served by these two payers make up half of the individuals who have private health insurance. It is…
Issues Encountered with Anthem’s Pre-approval
By Joseph Burns | From the Volume XXIV No. 11 – August 7, 2017 Issue
CEO SUMMARY: Since Anthem and AIM Specialty Health began a prior-authorization program for genetic testing July 1, a Northeast lab has not had any genetic tests approved through the new system. Physicians told the lab that the steps required for prior authorization were disruptive. Those …
CEO Describes Characteristics Of the Clinical Lab 2.0 Model
By Joseph Burns | From the Volume XXIV No. 7 – May 15, 2017 Issue
CEO SUMMARY: Moving away from volume-based care will not be easy for clinical labs. After all, high volume sustains labs. But labs seeking to transition away from fee-for-service to value-based care must have a seat at the table where decisions are made, said a lab CEO who is part of Proj…
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