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Aetna
Payers Request More Claims Documentation
By Robert Michel | From the Volume XXX, No. 7 – May 8, 2023 Issue
CEO SUMMARY: Both anecdotal evidence from lab professionals and numbers-based data from XiFin point to a problem: More payers require clinical labs to produce more documentation that a test claim i…
How Genomic Testing Labs Can Improve Their Relationships with Payers
By Robert Michel | From the Volume XXIX, No. 14 – October 10, 2022 Issue
CEO SUMMARY: For payers and health plans, it may be a matter of trust that initially curtails speedy reimbursement of new and novel genomic test claims. A panel …
Coverage, Reimbursement Still Difficult for New Lab Tests
By Robert Michel | From the Volume XXIX, No. 11 – August 8, 2022 Issue
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,…
Seven Doctors Settle Lab Test Fraud Case
By Robert Michel | From the Volume XXIX, No. 4 – March 14, 2022 Issue
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…
Federal Prosecutors Describe Illegal Lab Bribes to Physicians
By Robert Michel | From the Volume XXIX, No. 4 – March 14, 2022 Issue
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…
By 2027, Walgreens Wants 1,000 Primary Care Clinics
By Robert Michel | From the Volume XXVIII, No. 14 – October 18, 2021 Issue
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…
How to Achieve Success with Genetic Test Prior Authorization
By Robert Michel | From the Volume XXVIII, No. 10 – July 26, 2021 Issue
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…
CURRENT ISSUE
Volume XXXII, Number 16 – November 17, 2025
The Dark Report offers insights into innovative ways to engage employees, streamline workflows, and build talent pipelines. Standard Health Care’s Jennifer Fralick outlines strategies to retain talent and improve efficiency. Also, The Dark Report provides a review of NYU Langone Health’s Digital Pathology Implementation, and the Pathology director explains why smaller labs should consider DP.
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