TAG:
cpt
Systems Approach For Pre-Authorization Of Genetic Tests
CEO Summary: Pre-authorization of expensive genetic and molecular tests is a threat to local clinical laboratories and pathology groups if payers exclude them from provider networks in favor of labs which bid the lowest prices. But one major healthcare corporation believes there …
Payers Move to Pre-Authorize Expensive Genetic Tests
CEO Summary: Pre-authorization of expensive genetic and molecular tests is fast-becoming a priority for most of the nation’s health insurers. For clinical labs and pathology groups that don’t respond, this trend is a threat. On the other hand, because payers need all the skil…
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 …
Medically Unlikely Edits Are Back–and a Problem!
CEO SUMMARY: On January 1, 2009, CMS implemented Phase VIII of its policy on medically unlikely edits (MUEs) involving about 100 laboratory CPT Codes. It also began to deny whole claims, not just the “medically unlikely” parts of claims. After hearing of the problem in early …
Medicare Carrier Proposes No Pay for Vitamin D Test
CEO SUMMARY: Medicare contractor NGS wants to end payment to labs and physicians for routine Vitamin D testing. In a proposed local coverage determination (LCD), the Medicare carrier says it would cover Vitamin D testing only for patients with chronic kidney disease, osteomalacia…
Illinois Pathologists Dodge Medicaid CP Payment Cut
CEO SUMMARY: Pathologists in Illinois acted swiftly to this month’s announcement that the Illinois Medicaid program would cease to directly pay pathologists directly for clinical pathology professional services. The new policy was to take effect on October 1, 2008. As t…
Implementation Date For ICD-10 Is Proposed
CEO SUMMARY: Even though the transition from ICD-9 to ICD-10 will not be required until 2011, laboratories and pathology groups should have a transition plan in place. ICD-10’s 155,000 seven-digit codes will replace the 17,000 five-digit codes of ICD-9. Because of major…
Numerous Issues Identified With Bid Demo’s 303 Tests
CEO SUMMARY: One experienced expert in billing and coding was surprised at the list of 303 tests to be included in the Medicare Laboratory Competitive Bidding Demonstration Project. He notes that the list of 303 tests includes a number of codes and descriptions that are not consistent wit…
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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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