Palmetto GBA Issues Guidance On Billing NGS Test Panels

By Joseph Burns | From the Volume XXIII No. 3 – February 29, 2016 Issue

CEO SUMMARY: Across the lab industry, next generation sequencing is taking hold as an effective and efficient testing platform. In response, payers are developing coding and payment policies that may affect the finances of clinical labs. Last month, Palmetto GBA, a Medicare contractor, is…

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Payers Using Two Approaches To Price Molecular and Genetic Tests

By Joseph Burns | From the Volume XXIII No. 3 – February 29, 2016 Issue

EXECUTIVE SUMMARY: This analysis, unique to THE DARK REPORT, contrasts the decision of Palmetto GBA to distinguish between “hotspot” tumor panels (meaning those targeting 5 to 50 genes and 51 or more genes) versus “sequencing” tumor panels in coding and pricing NGS test panels, wi…

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At Mid-Year, Labs Struggle to Get Paid for Many Tests

By Joseph Burns | From the Volume XXI No. 10 – July 21, 2014 Issue

CEO SUMMARY: At a recent coding and billing conference, pathology and lab clients of one of the nation’s largest revenue management companies agreed that three trends have caused lower revenues since the start of 2014. One trend seen by labs involves higher deductibles and copayments fr…

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Changed Medicare Policy Adds to Regulatory Risk

By Joseph Burns | From the Volume XIX No. 13 – September 17, 2012 Issue

CEO SUMMARY: When Medicare’s National Correct Coding Initiative (NCCI) manual took effect on January 1, 2012, it contained a significant change in how prostate biopsy claims are to be coded. This change was widely overlooked by the pathology profession and even dismissed entirely for it…

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More Reimbursement Threats for Lab Testing

By R. Lewis Dark | From the Volume XVIII No. 1 – January 18, 2011 Issue

WE ARE NOW WELL INTO THE FIRST MONTH OF 2011 and already there are plenty of signs that reimbursement for both clinical laboratory testing and anatomic pathology testing will come under siege from a variety of sources this year. Take, for example, the rather rapid action by the Centers for M…

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Pre-authorization Coming For Pricey Molecular Tests

By Robert Michel | From the Volume XVII No. 6 – April 19, 2010 Issue

CEO SUMMARY: In response to the steep ramp-up in the utilization of genetic and molecular testing, the nation’s largest health insurers are preparing to institute new guidelines for coverage and reimbursement. These will include pre-authorization by physicians, a more effective genetic …

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Numerous Issues Identified With Bid Demo’s 303 Tests

By Robert Michel | From the Volume XIV No. 18 – December 31, 2007 Issue

CEO SUMMARY: One experienced expert in billing and coding was surprised at the list of 303 tests to be included in the Medicare Laboratory Competitive Bidding Demonstration Project. He notes that the list of 303 tests includes a number of codes and descriptions that are not consistent wit…

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Pumping Up Performance of Lab Billing & Collections

By Robert Michel | From the Volume XIV No. 4 – March 12, 2007 Issue

CEO SUMMARY: Coding, billing, collections, and compliance continue to grow in complexity, making management of the lab’s revenue cycle ever more difficult. One by one, a number of the nation’s largest laboratories are taking steps to automate management of their revenue cycle by utili…

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Baltimore Hospital Lab Problems Put Spotlight On CAP Inspections

By Robert Michel

CEO SUMMARY: Here’s an exclusive peek into a three-year battle between medical technologists wanting to do the right thing and a laboratory manager—backed by hospital administration—who aggressively stifled well-justified dissent. It is an inside look at one of the most grievous fai…

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Medicare “Bill Back” Policies Vary By Lab

By Robert Michel | From the Volume X No. 4 – March 24, 2003 Issue

CEO SUMMARY: When it comes to the subject of Medicare medical necessity, the classic “compliance conundrum” is again at work. Laboratories with conservative, strict compliance policies believe they are at a disadvantage at retaining physician-clients and winning new accounts when comp…

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