TAG:

cpt code

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 increas…

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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 …

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ASCP, CAP Ask Anthem to Roll Back Price Cuts

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…

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Anthem’s Cuts in AP Fees Could Put Patients at Risk

CEO SUMMARY: Consultants who work with anatomic pathologists have several theories about why Anthem is enacting deep cuts of 50% to 70% for the professional component of many anatomic pathology services. While they have different ideas about what motivates the nation’s second largest he…

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Anthem Rolling Out New Pathology CPT Code Cuts

This is a synopsis of a 2,120-word article in the July 1, 2019 issue of THE DARK REPORT (TDR). The full articles are available to members of The Dark Intelligence Group.  CEO SUMMARY: Anthem is making big changes to its relationships with anatomic pathology (AP) groups. Getting most o…

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ACLA: NCCI Guidelines Are a ‘Step Backwards’

CEO SUMMARY: In a letter to the National Correct Coding Initiative, the American Clinical Laboratory Association (ACLA) raised significant concerns about new language in the policy manuals for Medicare and Medicaid. ACLA said the new NCCI guidelines for molecular and other tests requiring…

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Nine Lab Groups Say New NCCI Policy Is Inconsistent

CEO SUMMARY: By its name alone, the National Correct Coding Initiative (NCCI) Policy Manual implies that it will be accurate and consistent with other coding initiatives. But nine groups representing various clinical laboratories say NCCI guidelines that the federal Centers for Medicare a…

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AP Groups Can Protect Revenue, Pathologist Compensation

CEO SUMMARY: Many anatomic pathology groups are watching their revenue decline and margins shrink on the same or greater case volume. These trends make it imperative to have a deeper understanding of the operational and financial variables that contribute to stability in the group’s fi…

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Senator Asks: Are Lab Test Payments Too High?

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 f…

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CMS Adjustments for Medicare Fee Schedule Might Be Too Late

This is a summary of two articles in the Nov. 13, 2018 issue of THE DARK REPORT. The complete articles are available only to paid members of the Dark Intelligence Group. CEO SUMMARY: On Nov. 2, the federal Centers for Medicare and Medicaid Services released its Physician Fee S…

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