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jane pine
“Waiver of Charges”: What Makes It Work
CEO SUMMARY: Little-used in the 1990s, when laboratory test ordering and billing practices were under intense scrutiny by federal regulators, the strategy of “free testing” is popping up in more regions around the country. To comply with compliance guidelines, labs using this strategy g…
Lab Marketing Strategy Triggers Legal Concerns
CEO SUMMARY: That famous phrase “everyone wants something for nothing” does not describe TennCare Select’s reaction to the “free testing” that Quest Diagnostics is performing for its beneficiaries. TennCare provides a real-world example of how this strategy can put a laboratory at o…
OIG Moves to Address “Usual Charge” Issue
CEO SUMMARY: Federal regulators are taking another crack at defining “usual charges.” Language in the proposed rules published last month precisely defines which payers should be included in determining “usual charges” and what charge basis to use for specific payers. Once effecti…
Pathology Group Conflicts Over Equity Vs. Salary
CEO SUMMARY: During the next two years, two of every three pathology group practices will see a change in pathologists, either through new hires or by resignation and retirement. These events fundamentally change the financial situation of the group, but since most groups are organized un…
AACC and CAP Meetings Generate Useful Insights
IT WAS A BUSY TIME LAST WEEK on the lab industry meeting circuit. THE DARK REPORT made the rounds and uncovered some valuable intelligence for lab directors and pathologists. First on the meeting tour was Philadelphia, site of the American Association of Clinical Chemistry (AACC) a…
Medicare “Bill Back” Policies Vary By Lab
CEO SUMMARY: When it comes to the subject of Medicare medical necessity, the classic “compliance conundrum” is again at work. Laboratories with conservative, strict compliance policies believe they are at a disadvantage at retaining physician-clients and winning new accounts when comp…
Client Bill Pricing Policy Rises To Medicare Level
CEO SUMMARY: Within the laboratory industry, there has been a decade-long debate over whether offering discount prices in client bill states could violate some Medicare regulations. UroCor, Inc. decided that an OIG opinion issued in December to a pathology company signaled a potential cha…
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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