By Joseph Burns, from the Volume XXVI No. 13 – September 23, 2019 issue
CEO SUMMARY: One association representing pathologists says new payment rates that Anthem, Inc., is introducing in 14 states do not cover the costs of performing anatomic pathology and clinical lab testing for the tests in question. Another association says the steep payment cuts threaten the viability of small and rural pathology groups. State-by-state, Anthem is
By Robert Michel, from the Volume XXVI No. 11 – August 12, 2019 issue
CEO SUMMARY: In 2017, an auditor for CMS alleged that True Health filed fraudulent claims and the federal Medicare program cut all payments to the lab company and one month later reduced the cut to 35% of the billed amount. Two months ago, CMS ended all payments again. These facts became public on July 2
By Joseph Burns, from the Volume XXVI No. 9 – July 1, 2019 issue
CEO SUMMARY: As of Aug. 1, Aetna will stop paying out-of-network pathologists for the professional component review of certain clinical pathology tests. Until now, the health insurer has paid for the professional component when out-of-network labs billed for clinical lab tests using the modifier 26. In a notice to labs, Aetna said it will pay
By Joseph Burns, from the Volume XXVI No. 7 – May 20, 2019 issue
CEO SUMMARY: Attendees at the Executive War College learned that CMS has taken steps to expand the number of hospital labs required to report their private payer lab test price data under the Protecting Access to Medicare Act, but the unbundling of certain test panels could be problematic. Problems can occur when labs either did
This is an excerpt from a 1,900-word article in the April 29, 2019 issue of THE DARK REPORT. The full article is available to members of The Dark Intelligence Group.
CEO SUMMARY: A new UnitedHealthCare (UHC) preferred lab network will launch July 1 with seven lab companies. In an April 22 announcement, UHC said physicians and
By Joseph Burns, from the Volume XXVI No. 6 – April 29, 2019 issue
CEO SUMMARY: UnitedHealthcare will launch a new preferred laboratory network with seven lab companies on July 1. In an April 22 announcement, UHC said physicians and consumers may continue to use its existing network of more than 300 labs currently in-network. One goal is to give patients a choice of labs based on price with
By Mary Van Doren, from the Volume XXVI No. 4 – March 18, 2019 issue
This is an excerpt from a 2,900-word article in the March 18, 2019 issue of THE DARK REPORT. The full article is available to members of The Dark Intelligence Group.
CEO SUMMARY: This is the first lab industry intelligence briefing which presents the lessons learned by a hospital system lab when it gathered, analyzed, and reported
By Joseph Burns, from the Volume XXVI No. 4 – March 18, 2019 issue
CEO SUMMARY: All clinical labs required to report their private payer lab test price data are now in the midst of collecting that data. One big change in PAMA reporting is that the federal Centers for Medicare and Medicaid Services now defines most hospital and health system labs as “applicable labs”and requires them to report
By Joseph Burns, from the Volume XXVI No. 3 – February 25, 2019 issue
CEO SUMMARY: At Northwell Health, the clinical laboratory team has been busy building and opening two new, large laboratory facilities. First to open was the lab in Little Neck, Queens, a shared lab with NYC Health and Hospitals. This lab will handle 36 million tests annually. The second lab to open is Northwell’s new core
By Joseph Burns, from the Volume XXVI No. 2 – February 4, 2019 issue
CEO SUMMARY: It is ironic that, after the federal Centers for Medicare and Medicaid Services (CMS) enacted the deepest price cuts to the Part B Clinical Laboratory Fee Schedule in more than 50 years, a U.S. Senator now asks CMS why it will pay billions more for lab testing. The question from Iowa Senator Chuck
