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Years of Biobank Experience Pay Off for Mayo Clinic Lab

THANKS TO 10 YEARS OF EXPERIENCE, an existing infrastructure for banking patient specimens, and the unique capabilities of its clinical laboratory organization, Mayo Clinic has been awarded a five-year, $142 million grant from the National Institutes of Health. Last…

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May 2, 2016 Intelligence: Late Breaking Lab News

Like the Sword of Damocles of Greek myth, market price reporting by labs under the Protecting Access to Medicare Act (PAMA) continues to hang over the heads of the nation’s clinical laboratories. However, instead of a threat, PAMA market price reporting may soon become a reality. News reports indi…

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Gene Testing Lab Goes ‘Cold Turkey,’ Stops Billing Health Plans

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 rev…

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How to Cover Genetic Tests Confounds Health Insurers

CEO SUMMARY: Managed care experts say health insurers are being overwhelmed by the number of new genetic tests and that many labs find it tough to get paid for these tests. UnitedHealthcare just announced it will require pre-authorization of molecular and genetic tests during 2016. Me…

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UnitedHealthcare Warns Labs: Don’t Waive Patient Fees

This article is an excerpt from a 1,500-word article in the March 21 issue of THE DARK REPORT. Full details of UHC’s battle against out-of-network labs, as well as its plans to begin requiring pre-authorization for genetic testing, are included in the original article, available to paid members…

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UnitedHealthcare Warns Labs Not to Waive Patient Fees

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 ins…

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Understanding the Future Of Laboratory Medicine

CEO SUMMARY: Healthcare’s transformation is now far enough along that most clinical labs and pathology groups are either feeling the financial pain or are excitedly developing ways to deliver more value from lab testing services. On April 26-27, at the 21st annual …

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Palmetto GBA Issues Guidance On Billing NGS Test Panels

CEO SUMMARY: Across the lab industry, next generation sequencing is taking hold as an effective and efficient testing platform. In response, payers are developing coding and payment policies that may affect the finances of clinical labs. Last month, Palmetto GBA, a Medicare contractor, is…

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Payers Using Two Approaches To Price Molecular, Genetic Tests

PRIVATE PAYERS AND MEDICARE contractors are taking divergent approaches to establishing coverage policies and setting prices for molecular and genetic tests. That’s what Kuo Bianchini Tong, MS, CEO of Quorum Consulting Inc., sees happening. “One approach seeks to recognize the c…

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How Mentors Can Best Train Young Lab Leaders

CEO SUMMARY: Mentoring will be the theme of a special learning track at this year’s Executive War College. Two nationally-respected experts on mentoring and leadership development will work with participating lab mentors and mentorees to help them advance their mentoring relationship. A…

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