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Aetna

Coverage, Reimbursement Still Difficult for New Lab Tests

CEO SUMMARY: Bringing a new proprietary diagnostic test to market is an arduous process. It takes patience and planning to complete the journey from test development to payer reimbursement. This slow process stems from the fact that the healthcare reimbursement system is fragmented,…

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Seven Doctors Settle Lab Test Fraud Case

CEO SUMMARY: In January, a U.S. Attorney from East Texas announced that seven physicians and a hospital CEO had agreed to settle allegations of fraud involving the payment of bribes in exchange for lab test orders. This is a positive development for the clinical laboratory profession because it…

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Federal Prosecutors Describe Illegal Lab Bribes to Physicians

PATHOLOGISTS AND CLINICAL LAB MANAGERS SHOULD WELCOME every federal prosecution of a physician who accepts illegal bribes and inducements in exchange for laboratory test referrals. If physicians understood that federal prosecutors would file criminal charges against them for this behavior, fewer doct…

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By 2027, Walgreens Wants 1,000 Primary Care Clinics

PRIMARY CARE IS COMING TO A RETAIL CLINIC NEAR YOU! It may not happen overnight, but it will happen. Walgreens Boots Alliance just announced its goal of building 1,000 primary care clinics at its retail pharmacies by 2027. CVS and Walmart have similar plans. These plans were a…

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How to Achieve Success with Genetic Test Prior Authorization

AS MANAGED CARE PAYERS INCREASINGLY REQUIRE PRIOR AUTHORIZATION FOC GENETIC TESTS, clinical laboratories should understand the ins and outs of what it takes to get reimbursed for testing they provide.  Almost all payers now require prior authorization (P…

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