By Joseph Burns, from the Volume XXVI No. 11 – August 12, 2019 issue
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,
By Joseph Burns, from the Volume XXVI No. 9 – July 1, 2019 issue
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
By Joseph Burns, from the Volume XXVI No. 9 – July 1, 2019 issue
CEO SUMMARY: As of Aug. 1, Aetna will stop paying out-of-network pathologists for the professional component review of certain clinical pathology tests. Until now, the health insurer has paid for the professional component when out-of-network labs billed for clinical lab tests using the modifier 26. In a notice to labs, Aetna said it will pay
By Joseph Burns, from the Volume XXVI No. 9 – July 1, 2019 issue
CEO SUMMARY: Anthem is making big changes to its relationships with anatomic pathology groups. Getting most of the attention at the moment are the insurer’s letters announcing price cuts for anatomic pathology services of 50% to 70% of Medicare fees. But another major change may also trigger negative consequences for pathologists. Anthem is moving pathology
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 R. Lewis Dark, from the Volume XXVI No. 9 – July 1, 2019 issue
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.
By Joseph Burns, from the Volume XXVI No. 7 – May 20, 2019 issue
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
By Joseph Burns, from the Volume XXVI No. 7 – May 20, 2019 issue
CEO SUMMARY: Attendees at the Executive War College learned that CMS has taken steps to expand the number of hospital labs required to report their private payer lab test price data under the Protecting Access to Medicare Act, but the unbundling of certain test panels could be problematic. Problems can occur when labs either did
By Joseph Burns, from the Volume XXVI No. 6 – April 29, 2019 issue
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
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
