TAG:
cpt code
How Genomic Testing Labs Can Improve Their Relationships with Payers
CEO SUMMARY: For payers and health plans, it may be a matter of trust that initially curtails speedy reimbursement of new and novel genomic test claims. A panel …
Insurers Get Aggressive with Years-Old Audits, Searching for Lab Overpayments
This is an excerpt of a 1,971-word article in the July 26, 2021 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: Not only are health insurers looking back to find lab overpayments and funds paid erroneously, but…
Insurers Get Aggressive with Years-Old Audits
CEO SUMMARY: Not only are health insurers looking back to find overpayments and funds paid erroneously, but payers also are requiring documentation for overpayments. If clinical labs and anatomic pathology groups do not appeal such claims quickly, they may be liable for any amount i…
One Genetic Test CPT Code Earns ‘Fraudomatic’ Title
CEO SUMMARY: Several genetic testing companies have noticed that some of the nation’s Medicare Administrative Contractors (MAC) pay about $2,000 for test claims billed with CPT code 81408. From 2018 through and 2019, the number of 81408 claims rose dramatically at just two of thes…
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…
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 …
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…
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…
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…
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…
CURRENT ISSUE
Volume XXX No. 4 – March 6, 2023
Readers will uncover a theme of mergers and consolidations running throughout this issue of The Dark Report. Case in point is our story about the pending merger between Sanford Health and Fairview Health Services. If the deal goes through, the new system will have 58 hospitals across five states. The Dark Report also notes revenues from Labcorp’s acquisition of Ascension Health, and reports on the creation of a major MT training center in Utah.
See the full table of contentsHow Much Laboratory Business Intelligence Have You Missed?
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