CEO SUMMARY: Under guidelines the National Correct Coding Initiative issued last year, many clinical laboratories are not getting paid for some tests. The rates of denial for labs running mostly molecular tests could range from 40% to 100% of revenue, one billing expert said. Implemented Jan. 1, the guidelines apply to labs running tests in
Tag: gene test
GENETIC TESTS REPLACED BOBBLEHEAD DOLLS AS THE GIVEAWAY at yesterday’s Baltimore Ravens home game against the Cleveland Browns. That’s a first in the world of professional sports!
Tens of thousands of football fans received a fee DNA test kit as they entered the stadium on Sunday. The event was sponsored by Orig3n, a genetic testing company
CEO SUMMARY: Pre-authorization of genetic tests is coming to physicians serving patients insured by Anthem, Inc. Its specialty benefits management company, AIM Specialty Health, will manage the program. AIM will work with InformedDNA, a company that specializes in genetic testing clinical decision support and genetic counseling for health insurers. Anthem has about 40 million members
This is an excerpt from a 1,485-word article in the June 5, 2017 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group.
CEO SUMMARY: At a time when most molecular and genetic testing companies are
CEO SUMMARY: At a time when most molecular and genetic testing companies are struggling to gain coverage for their tests, this Silicon Valley-based lab company has become an in-network lab provider for a number of health insurers—including three of the nation’s largest payers. It did this by establishing a patient-friendly price of $249 for its
TODAY, THE LAB INDUSTRY FACES A CONTRADICTION when setting prices for individual lab tests. At one extreme, a certain sector of labs seeking to win exclusive managed care contracts sets high-volume routine test prices at or below the fully-loaded cost to perform those tests. At another extreme, laboratory companies with specialty molecular and genetic tests
There is a new development in one of the whistleblower lawsuits filed against several lab companies that offered specialty cardiology tests. Earlier this month, the Department of Justice announced a settlement with Quest Diagnostics involving its acquisition of Berkeley HeartLab, which was acquired by Quest in 2011. The DOJ said that Quest agreed to pay
CEO SUMMARY: For three years, Cigna has required genetic counseling for members seeking genetic testing for hereditary breast, ovarian, and colorectal cancer, and for a particular heart condition. Such counseling increased member satisfaction, causing Cigna to expand the program. It now requires genetic counseling with an independent board-certified genetics specialist for members considering whole exome
CEO SUMMARY: Last year, Kailos Genetics stopped collecting third-party payment, dropped its prices sharply, and started marketing its genetic-screening tests directly to consumers and physicians. At the time, 100% of its revenue came from third-party payers. Today, it gets 100% of its revenue from consumers. After eliminating third-party payment, revenue dropped precipitously, but is now
CEO SUMMARY: UnitedHealthcare directly tackled the issue of out-of-network labs waiving or capping copayments, coinsurance and deductibles that are to be paid by patients. In a network bulletin this month, UHC said that such arrangements may violate federal law and could lead to state insurance department investigations into false claims. In the same bulletin to