Tag: clinical laboratories

Judge Issues Split Ruling on Quest’s Motion to Dismiss

CEO SUMMARY: There have been significant developments in the case against Quest Diagnostics for allegedly overcharging uninsured patients for clinical laboratory tests. This second section covers the federal judge’s most recent decisions, along with an assessment of how the plaintiffs and the defendent each received favorable rulings.
First of Two Parts: Section Two
IN THE FEDERAL LAWSUIT

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Lab Benefit Managers Want to Help Health Plans

CEO SUMMARY: Laboratory benefit management companies that offer a range of services to health insurers are gaining influence over clinical lab testing in important ways. On behalf of health insurers, LBMs will select labs for a payer’s network, then manage that network. They also manage claims and lab-test utilization, often reviewing medical necessity. A primary

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ICD-10 Gives Payers More Data About Lab Claims

CEO SUMMARY: Evidence shows that adoption of ICD-10 diagnosis codes in 2015 made it possible for health insurers to track clinical laboratory testing more closely, ask more questions about those tests, and deny coverage. Increased detail about each patient’s condition has led to increased demands for medical-necessity documentation and to denied payments of as much

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ICD-10 Codes Give Payers More Data About Lab Claims

This is an excerpt of a 1,484-word article in the Nov. 25, 2019 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group.
CEO SUMMARY: It’s an unreported trend tracked only by THE DARK REPORT, but which is essential reading for clinical labs and pathology groups that must

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How Labs Can Add Value for Providers, Insurers, Pharma

CEO SUMMARY: For pathologists and clinical, molecular, and genetic testing labs, appropriate reuses of lab data can provide a new source of revenue. Labs that serve as preferred providers of diagnostic testing data can help health systems, ordering physicians, pharmaceutical companies, and other organizations when they reuse lab test data to support evidence-based care and

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Labs Need to Act on New Medicare Enrollment Rules

CEO SUMMARY: For all healthcare providers—including clinical laboratories and pathology groups—a new rule became effective this month. The rule allows Medicare to revoke or deny enrollment if a provider or supplier’s affiliates pose an undue risk of fraud. Lawyers familiar with the “Program Integrity Enhancements to the Provider Enrollment Process” rule are concerned about its

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Medicare Affiliation Rule Targets Criminal Behavior

CEO SUMMARY: Under a new federal rule in effect this month, all healthcare providers—including clinical laboratories and pathology groups—will need to scour the records of all officers, directors, and affiliates to identify any that have had negative dealings with CMS or other federal enforcement agencies. Under the rule, the Medicare program is likely to target

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