Tag: cpt

Dermatologists Say Anthem Cuts Affect Patient Care

CEO SUMMARY: Deep cuts in what Anthem pays pathologists for the professional component for certain AP services are having a harmful effect on the long-standing relationships that dermatologists have with dermatopathologists, some physicians say. By disrupting these relationships, Anthem is harming patient care, they add. Since late last year, in a growing number of states,

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AP Practices Cautioned to Focus on Expenses

CEO SUMMARY: Reviewing an AP practice’s expenses is vitally important today when payers are cutting reimbursement. In the past, government and private payers paid more for the technical and professional components of anatomic pathology work, but those rates have eroded. While conversations about revenue tend to obscure the need to talk about expenses, effective financial

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Aetna, Anthem to Pay Pathology Groups Less

TWO OF THE NATION’S LARGER HEALTH INSURERS—AETNA AND ANTHEM— ARE CUTTING WHAT THEY PAY for the professional component of certain clinical and anatomic pathology codes.

In its communications with pathology groups about this policy change, Aetna says it will no longer pay for most clinical laboratory claims submitted with the modifier 26 for professional component services.

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CMS, Lab Groups Begin Talks About Issues with NCCI Edits

SERIOUS PROBLEMS WITH THE NEW GUIDELINES for the National Correct Coding Initiative (NCCI) that were  implemented on Jan. 1 have caused nine clinical laboratory associations and groups to come together and voice their concerns to the federal Centers for Medicare and Medicaid Services (CMS).

CMS implemented those changes on Jan. 1, resulting in confusion among labs

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Improve Your AP Group’s Financial Performance

CEO SUMMARY: Across the nation, health insurers are paying less for anatomic pathology services. This shrinks pathology group revenue and reduces pathologist compensation. Savvy pathology groups are responding to this trend by reviewing long-standing processes in their coding, billing, and collections department. Their goal is to update these billing and collections processes in ways that

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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 multiple steps for one specimen reduce transparency, increase the administrative burden on

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