TAG:
cpt code
Molecular Code Stacks Now in the Payers’ Bull’s Eye
LIKE A STEAM BOILER READY TO EXPLODE FROM TOO MUCH PRESSURE, the nation’s health insurers have reached a point of no return on the subject of code-stacked claims for genetic testing and molecular diagnostics assays. Simply put, payers are ready to tackle this sensitive issue. Payers have reasonabl…
Palmetto GBA Announces Molecular Test Registry
CEO SUMMARY: Palmetto GBA, the nation’s largest Medicare Administrative Contractor (MAC), is asking labs in the J1 jurisdiction to submit applications for each molecular test they run. Molecular assays will receive a unique five-digit alpha-numeric identifier (Z-code) that will be enter…
Rite Aid Offers Free Tests to Preferred Customers
CEO SUMMARY: National pharmacy chain Rite Aid now offers free clinical laboratory tests to members of its customer-rewards program once they reach certain spending levels. After the customer’s specimen is tested, the laboratory test results are sent directly to the customer’s local Ri…
Medicare Carrier Plans to Reject Molecular Claims
CEO SUMMARY: In September, Palmetto, a Medicare carrier serving California and seven other states, made public two draft local coverage determinations (LCDs) that revamp its coverage guidelines for molecular diagnostic tests (MDT) and laboratory-developed tests (LDT). All labs su…
Office-Based Physicians Want In-Clinic Laboratories
CEO SUMMARY: Interest by office-based physicians in creating an in-clinic medical testing laboratory is on the increase. This has direct consequences for independent commercial labs, hospital lab outreach programs, and anatomic pathology groups, since office- based physicians are…
G-Men Mistakenly Raid Pathology Lab in Calif.
CEO SUMMARY: On February 10, 15 armed agents from the Department of Justice (DOJ) arrived at a pathology laboratory in Chico, California, to serve a search warrant and seize billing records, computers, and other evidence believed to be associated with fraudulent billing for CPT c…
More Reimbursement Threats for Lab Testing
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…
Pathologists Can Still Earn Medicare PQRI Incentives
CEO SUMMARY: During 2010, the Medicare Physician Quality Reporting Initiative (PQRI) will pay a 2% bonus to pathologists who register and report data on 80% of their cases for the specified CPT codes. However, independent pathology laboratories still cannot participate in the PQR…
Letter to Editor on EMR Donations, Deeply-Discounted Client Prices
Dear Editor: Because THE DARK REPORT is willing to tackle tough issues regarding the business end of the pathology profession, I am writing to call attention to a serious situation. What follows is presented as mostly factual and minimally perceptive. While I have no fe…
Pre-authorization Coming For Pricey Molecular Tests
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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Volume XXXII, No. 7 – May 12, 2025
Economic, Tech changes drive lab concerns, The Dark Report provides insights from the Executive War College speakers about how clinical labs can use business strategies and tactics to handle the new tariffs, future regulations, and artificial intelligence (AI). Also, this issue provides guidance on how labs and pathologists should prepare for payer audits.
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