TAG:

care contracts

Fla. Blue Cross Contract May Be Next Battleground

CEO SUMMARY: In Florida, the Blue Cross Blue Shield contract is coming up for renewal and the question is whether it will renew as exclusive to one national lab company. But Florida is not the only state where BCBS plans are planning to issue new contracts. Among the Blues plans that may …

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Useful Lessons for Labs That Report PAMA Data

CEO SUMMARY: Will clinical labs heed the lessons learned from the first PAMA private payer market price reporting cycle that CMS conducted in 2017? One major difference is that the definition of applicable laboratories now includes most hospital labs. This creates the opportunity for a la…

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ProMedica, Sonic Form Lab Outreach Joint Venture

CEO SUMMARY: Fast-growing ProMedica Health System of Toledo, Ohio, agreed to a laboratory joint venture with Sonic Healthcare USA. As lab budgets and prices for lab tests are squeezed downward, ProMedica sees opportunity to add volume to this new core lab facility to improve efficiency an…

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New Aetna, UHC Contracts Create Openings for Labs

CEO SUMMARY: New national lab contracts that LabCorp and Quest announced in May could disrupt the lab testing market in ways regional labs can exploit, experts said. Health plans entered these new contracts after realizing that the exclusive network contracts do not work, one lab consulta…

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Rural Hospital Group Says Lab Billing Model Is Legal

CEO SUMMARY: In recent years, many rural hospitals have entered into agreements to expand their laboratory outreach businesses. In an interview, the president of the National Association of Rural Hospitals said rural hospitals often bill for lab outreach services under Medicare’s 70/30 …

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Rural Hospital Spokesman: Hospital Lab Outreach Programs Are Legal

CEO SUMMARY: As the debate grows more heated, supporters of hospital outpatient department (HOPD) billing schemes have ramped up their defense of the practice. The president of the National Association of Rural Hospitals tells THE DARK REPORT that rural hospitals…

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Why Lab Companies Buy Bankrupt Rural Hospitals

CEO SUMMARY: Seeking the higher lab-test payment rates that insurers pay hospital labs, some lab testing companies are buying rural, financially-struggling hospitals in what may be the latest twist on the pass-through billing strategy that certain lab testing firms have found to be lucrat…

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Lab companies and bankrupt hospitals: Dancing around medical billing fraud

This is an excerpt from a 2,000-word article in the May 29, 2018 issue of THE DARK REPORT. The complete article is to all readers as long as the article limit has not been reached, and always available to paid members of the Dark Intelligence Group. …

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What Are Lab Industry’s True Major Issues?

WE’VE JUST FINISHED A FASCINATING WEEK IN NEW ORLEANS, at the 23rd annual Executive War College. More than 820 lab leaders were present to hear 104 interesting speakers in 65 unique sessions. Collectively, this group represented as much as $20 billion in annual clinical lab and pathology r…

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Is the Worm Turning in Favor of Hospital Labs?

SINCE THE MID-1990S, HOSPITAL OUTREACH LABORATORY PROGRAMS have lost market share steadily to the nation’s biggest public lab companies. In these two decades, public lab companies traded deeply-discounted lab test prices to health insurers in exchange for exclusive network provider status. Then, a…

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