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Medicare Taken to Task about Molecular Test Pricing Method

EDITOR’S NOTE: Submitted by Lâle White, CEO of XIFIN, Inc., of Carlsbad, California, this letter describes the problems caused by the Medicare program’s failure, as of January 1, 2013, to be ready to process and reimburse lab test claims for more than 100 new mo…

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April 15, 2013 “Intelligence: Late Breaking Lab News”

Geisinger Health System broke ground last month on construction of a new $52 million medical laboratory facility. It will be 115,000 square feet and will be located at the site of the Geisinger Medical Center in Danville, Pennsylvania. LAB COMPANY COMPLET…

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Anticipating Washington’s Next Blows to Lab Testing

CEO SUMMARY: With the advent of 2013, almost every lab was responding to some type of price cut. Clinical labs are dealing with the sequential, multi-year cuts to the Medicare Part B Lab Test Price Schedule. Anatomic pathology labs are still adjusting to the expiration of the TC Grandfath…

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Urologists Weigh in on Prostate Biopsy Testing

CEO SUMMARY: Based on an impressive number of 4,230,129 vials collected from 437,937 biopsies, the new study is expected to add fuel to the fire of the ongoing debate about the appropriate number of prostate biopsies physicians should collect and refer to pathology labs for cancer testing…

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Palmetto’s Prostate Biopsy Policy Removed after Talks with CMS

THERE IS SOME POSITIVE LAB INDUSTRY NEWS that has not been widely reported yet. It involves a decision to change an unwelcome Medicare policy that limited the number of prostate biopsy specimens per case that would be reimbursed. After discussions between lab industry groups and the federal …

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Congress May Respond to Tough CLIA PT Penalties

CEO SUMMARY: For years, severe penalties in cases where a laboratory has inadvertently erred in handling proficiency testing (PT) specimens have been a point of contention between the Centers for Medicare & Medicaid Services (CMS) and the clinical laboratory profession. Two bills prop…

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New BlueCard Policies Affect Lab Test Claims

CEO SUMMARY: This new policy from the Blue Cross and Blue Shield Association (BCBSA) becomes effective on October 14, 2012. No longer can a local lab provide service to a member under the BlueCard program and be paid by the local plan in the region where the service was provided….

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MD Self-Referral Issues Target of Utilization Study

CEO SUMMARY: When it comes to the in-office ancillary service (IOAS) exception to physician self-referral, the issue of in-clinic pathology services has become a hot potato. Publication in Health Affairs of a study of urologists’ self-referral of their patients for anatomic pathology se…

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ACLA Has its Say Regarding Molecular Dx Proposals

CEO SUMMARY: It is not known how many public comments have been submitted to Palmetto GBA, the big Medicare carrier, in response to its published proposals to change how code stacked claims for genetic and molecular tests will be handled, effective February 27, 2012, for labs in Medicare …

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Forecast: Tough Fee Cuts Are in Labs’ Future

EVERY CLINICAL LABORATORY AND ANATOMIC PATHOLOGY GROUP PRACTICE in the United States should prepare for some big-time financial belt-tightening during the next 36 months. That certainly is the message coming from intense budget battles unfolding in Washington, DC, this fall. Most of you reading this…

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