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 Joseph Burns, from the Volume XXVI No. 12 – September 3, 2019 issue
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 health insurer, they agree that such reductions in payments will have a
By Mary Van Doren, from the Volume XXVI No. 9 – July 1, 2019 issue
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 of the attention at the moment are the
By Joseph Burns, from the Volume XXVI No. 6 – April 29, 2019 issue
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 multiple steps for one specimen reduce transparency, increase the administrative burden on
By Joseph Burns, from the Volume XXVI No. 5 – April 8, 2019 issue
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 finances and pathologist compensation. One expert on the financial complexity of anatomic
By Joseph Burns, from the Volume XXVI No. 5 – April 8, 2019 issue
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 and Medicaid Services issued in December and implemented on Jan. 1 are inconsistent
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
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 Schedule for 2019. CMS says it will expand
By Joseph Burns, from the Volume XXV No. 16 – November 13, 2018 issue
CEO SUMMARY: On Nov. 2, the federal Centers for Medicare and Medicaid Services released its Physician Fee Schedule for 2019. It says it will expand the number of labs from which it collects data about the lab test prices paid by private health insurers. While some labs may welcome these changes, groups representing clinical laboratories
By Joseph Burns, from the Volume XXV No. 15 – October 22, 2018 issue
CEO SUMMARY: Each year since 2015, Medicare officials have posted the prices charged by every physician. That now makes it possible for pathology group practices to conduct a price study of their region and state to learn how their group’s prices compare with other pathology providers. A national pathology consultant points out that one way
