TAG:
cpt
Reimbursement System Fails Labs and Patients
There is confusion and disruption in the molecular testing sector of the clinical lab testing industry. That’s because both government and private payers were not ready to process and reimburse for the 100+ new molecular CPT test codes on January 1, 2013. That is the date when the Medicare program…
Payers Bolix MDx Codes, Labs Unpaid for Months
CEO SUMMARY: Clinical laboratories complain that implementation of a new payment system for molecular tests has been a disaster since January 1. Most contractors for the federal Centers for Medicare & Medicaid Services have not paid labs for molecular tests billed thi…
One Lab’s Revenue Loss Due to CMS’ Slow Process
CEO SUMMARY: How is it that some commercial payers for one lab running molecular tests have continued to pay the lab for tests it has run this year, but contractors for CMS have so far failed to pay? That’s the question one lab CEO is asking. Both the commercial payers and the CMS contr…
Medicare Taken to Task about Molecular Test Pricing Method
EDITOR’S NOTE: Submitted by Lâle White, CEO of XIFIN, Inc., of Carlsbad, California, this letter describes the problems caused by the Medicare program’s failure, as of January 1, 2013, to be ready to process and reimburse lab test claims for more than 100 new mo…
Experts Say Labs May Start to Receive MDx Payments
CEO SUMMARY: In the fourth month of the current year, there is plenty of confusion and uncertainty over how the Medicare program will establish prices for the new molecular CPT codes and when both government and private payers will begin to regularly reimburse laboratorie…
Anticipating Washington’s Next Blows to Lab Testing
CEO SUMMARY: With the advent of 2013, almost every lab was responding to some type of price cut. Clinical labs are dealing with the sequential, multi-year cuts to the Medicare Part B Lab Test Price Schedule. Anatomic pathology labs are still adjusting to the expiration of the TC Grandfath…
Palmetto’s Prostate Biopsy Policy Removed after Talks with CMS
THERE IS SOME POSITIVE LAB INDUSTRY NEWS that has not been widely reported yet. It involves a decision to change an unwelcome Medicare policy that limited the number of prostate biopsy specimens per case that would be reimbursed. After discussions between lab industry groups and the federal …
Road Map to Most Pressing Trends In Healthcare
YOU SHOULD FIND THIS ISSUE OF THE DARK REPORT TO BE A USEFUL ROAD MAP to several of the major trends now confronting clinical labs and pathology groups across the United States. One trend involves payer efforts to control the cost of lab tests. A second trend centers upon accountable…
Low 2013 Molecular Rates May Bankrupt Some Labs
CEO SUMMARY: Many of the recently issued reimbursement rates for molecular diagnostic tests are inadequate and in fact are lower than the cost of running the tests, lab experts say. Smaller laboratories that specialize in developing and selling molecular tests could be forced to close. As…
Delivering Added Value = More Lab Reimbursement
WILL HISTORY LOOK BACK ON 2013 AND DECLARE IT to have been a watershed year for the clinical laboratory testing industry? I ask that question because many of you are telling us here at THE DARK REPORT that you expect rapid and unprecedented changes in the lab testing marketplace in your community or …
CURRENT ISSUE
Volume XXXII, No. 6 – April 21, 2025
Now that a federal judge has vacated the FDA’s LDT rule, The Dark Report analyzes the judgement and notes the various steps the FDA could take in response. Also, lab testing at pharmacies is proving to be less successful than was once anticipated.
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