This is an excerpt of a 1,460-word article in the Jan. 6, 2020 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group.
CEO SUMMARY: Here are early insights about a federal compliance reform that has not gotten much attention among clinical laboratory and anatomic pathology managers. CMS
By Joseph Burns, from the Volume XXVII No. 1 – January 6, 2020 issue
CEO SUMMARY: Among hospital administrators, the popular wisdom is that their clinical lab is a cost center. This thinking leads them to consider drastic cost-management strategies that include partnering with commercial labs to manage in-hospital lab testing and the outright sale of lab outreach programs. On the other side of this debate, innovative health system
By Joseph Burns, from the Volume XXVII No. 1 – January 6, 2020 issue
CEO SUMMARY: In a federal lawsuit against Laboratory Corporation of America, plaintiffs who were uninsured or underinsured charged the lab company with engaging in “business practices that trick and harass customers into paying excessive prices.” Plaintiffs made this and other claims in court documents alleging that LabCorp overcharged them by two to five and as
By Joseph Burns, from the Volume XXVII No. 1 – January 6, 2020 issue
CEO SUMMARY: When CMS and the OIG issued proposed rules last fall to make it easier for providers to participate in value-based and coordinated care arrangements, they considered excluding clinical labs, pharma companies, and DME firms because of concerns that the proposed rules could promote lab test fraud. Now, labs will have to wait for
By Mary Van Doren, from the Volume XXVI No. 17 – December 16, 2019 issue
This is an excerpt of a 3,163-word article in the Dec. 16, 2019 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group.
CEO SUMMARY: There was plenty of bad news in 2019 for clinical labs and pathology groups. Yet lurking inside this news are clear opportunities –
By Joseph Burns, from the Volume XXVI No. 17 – December 16, 2019 issue
CEO SUMMARY: Health Network Laboratories cut costs and shortened lab test turnaround time by converting paper requisitions to digital data. It did so by scanning paper requisitions and having a vendor do the required data entry. This helped the lab reduce errors in its patient data. Using this paper-to-digital system allowed the lab to adopt
By R. Lewis Dark, from the Volume XXVI No. 17 – December 16, 2019 issue
Is it a coincidence that a number of uninsured consumers filed separate lawsuits in federal courts against Laboratory Corporation of America and Quest Diagnostics—alleging, in both cases, that they were overcharged for clinical laboratory tests—just months before the federal government published final rules requiring hospitals and other providers to publish their prices?
Last month, the federal Centers
By Joseph Burns, from the Volume XXVI No. 16 – November 25, 2019 issue
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
By Joseph Burns, from the Volume XXVI No. 16 – November 25, 2019 issue
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
By Joseph Burns, from the Volume XXVI No. 16 – November 25, 2019 issue
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
