By Joseph Burns, from the Volume XXVI No. 16 – November 25, 2019 issue
CEO SUMMARY: Court documents filed in U.S. District courts in New Jersey and North Carolina provide details about how each of the two lab companies set lab test prices differently—as much as 10 times higher—for cash-paying patients than for patients who have Medicare, Medicaid, or commercial health insurance plans. In court filings, plaintiffs allege that
By Joseph Burns, from the Volume XXVI No. 16 – November 25, 2019 issue
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 increased demands for medical-necessity documentation and to denied payments of as much
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 labs and pathology groups that must
By R. Lewis Dark, from the Volume XXVI No. 16 – November 25, 2019 issue
IMPLEMENTATION OF ICD-10 DIAGNOSIS CODES in the United States happened on Oct. 1, 2015. At that time, a national laboratory association predicted that use of ICD-10 codes would cause Medicare Administrative Contractors (MACs) to pay labs less often and with lower reimbursement.
The Dark Report agreed with this prediction and published the warnings of the American Clinical
By Mary Van Doren, from the Volume XXVI No. 15 – November 4, 2019 issue
This is an excerpt of a 2,027-word article in the Nov. 4, 2019 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group.
CEO SUMMARY: Under a new federal rule in effect this month, all healthcare providers—including clinical laboratories and pathology groups—will need to scour the records of
By Joseph Burns, from the Volume XXVI No. 15 – November 4, 2019 issue
CEO SUMMARY: One big development affecting the health insurance business is how four of the nation’s largest health insurers are diversifying in significant ways. Last spring, a healthcare strategist explained how each of these companies has spent billions of dollars in recent years to acquire other healthcare companies that are not part of the traditional
By Joseph Burns, from the Volume XXVI No. 15 – November 4, 2019 issue
CEO SUMMARY: For pathologists and clinical, molecular, and genetic testing labs, appropriate reuses of lab data can provide a new source of revenue. Labs that serve as preferred providers of diagnostic testing data can help health systems, ordering physicians, pharmaceutical companies, and other organizations when they reuse lab test data to support evidence-based care and
By R. Lewis Dark, from the Volume XXVI No. 15 – November 4, 2019 issue
THERE IS AN OFT-REPEATED ADAGE THAT what the government gives you with one hand, it takes away with the other. This may be an apt description of the new Medicare final rule that takes effect today, called the Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC).
The goal of the new rule is to give
This is an excerpt of a 2,882-word article in the Oct. 14, 2019 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group.
CEO SUMMARY: Four trends are disrupting the nation’s healthcare system in ways that no one would have predicted just a few decades ago – including startling
By R. Lewis Dark, from the Volume XXVI No. 13 – September 23, 2019 issue
IT’S CALLED THE OPIOD CRISIS AND IT’S OFTEN A MAJOR STORY in the nightly news. In 2017, deaths from drug overdoses totaled 70,237, of which 68% (47,600) were opioid overdose deaths, according to the federal Centers for Disease Control and Prevention.
Across the nation, government health officials and healthcare providers struggle to address the problems of opioid
