Technical Assessment Challenges for Z-Code Applications

By Scott Wallask | From the Volume XXX, No. 10 – July 10, 2023 Issue

CEO SUMMARY: Effective on Aug. 1, UnitedHealthcare will require Z-code submissions for many genetic tests. During a recent webinar, experts tackled a topic that may prove troublesome for labs seeking Z-codes: technical assessments. Key advice is to provide specific data about clin…

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UnitedHealthcare’s Z-code Policy Starts on Aug. 1

By Robert Michel | From the Volume XXX, No. 10 – July 10, 2023 Issue

CEO SUMMARY: UnitedHealthcare’s (UHC) response to the ever-growing number of unique genetic tests and the continuing growth in the volume of those claims is a new policy. Effective Aug. 1, UHC will require a Z-code with genetic test claims. This req…

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Stressful Weeks Ahead for Labs Thanks to Z-codes

By R. Lewis Dark | From the Volume XXX, No. 10 – July 10, 2023 Issue

We are not alone in recognizing that UnitedHealthcare’s…

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ICD-10 Gives Payers More Data About Lab Claims

By Joseph Burns

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…

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ICD-10 Codes Give Payers More Data About Lab Claims

By Mary Van Doren

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 …

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Lawsuits Alleging Overcharges to Proceed in Two Courts in 2020

By Joseph Burns

CEO SUMMARY: Two lawsuits filed in federal courts against Laboratory Corporation of America and Quest Diagnostics may have consequences for the entire lab industry. The plaintiffs are patients who allege that the two defendant lab companies charged them as much as 10 times more than what …

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2019’s Top 10 Lab Stories Reveal Major Laboratory Industry Trends

By Mary Van Doren

This is an excerpt of a 3,163-word article in the Dec. 16, 2019 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: There was plenty of bad news in 2019 for clinical labs and pathology groups. Yet lurking inside this new…

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ASCP, CAP Ask Anthem to Roll Back Price Cuts

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…

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Anthem’s Cuts in AP Fees Could Put Patients at Risk

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 he…

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What Comes Next for the Pathology Profession?

By R. Lewis Dark | From the Volume XXVI No. 12 – September 3, 2019 Issue

IT MAY NOT BE A COINCIDENCE THAT MANY RECENT NEWS CYCLES have more negative pathology news than positive pathology news. After all, laboratory medicine is at the core of most clinical care delivered to patients, so it’s no coincidence that pathology—both clinical and anatomic—is a prime target…

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