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Attorney Explains 70/30 Rule, Pass-Through Bill Arrangements

HOW THE LAB OUTREACH BUSINESSES of rural hospitals originate lab specimens and bill for lab tests is getting increased scrutiny. The reason for this rise in interest is that a growing number of rural hospitals are generating almost as much revenue from laboratory outreach testing as they get from all…

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Rural Hospital Group Says Lab Billing Model Is Legal

CEO SUMMARY: In recent years, many rural hospitals have entered into agreements to expand their laboratory outreach businesses. In an interview, the president of the National Association of Rural Hospitals said rural hospitals often bill for lab outreach services under Medicare’s 70/30 …

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Theranos News Gets Worse for the Former Silicon Valley Hero

CEO SUMMARY: In a tale of two fraudsters, the Department of Justice has filed a warning shot to all technology startups: Criminal indictments against Elizabeth Holmes and Ramesh “Sunny” Balwani could mean prison time and massive fines. In this latest Theranos news, The DOJ ci…

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In Lawsuit Against HHS, ACLA Has Strong Positions

CEO SUMMARY: Rulings from Judge Amy Berman Jackson of the U.S. District Court in Washington, D.C., are expected soon in the ACLA’s lawsuit against HHS concerning the PAMA final rule that set the course for the new Medicare CLFS rates implemented in January 2018. One lawyer following the…

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Theranos’ Elizabeth Holmes Prepares to Meet Justice

IT’S NOW CLEAR THAT TWO CLINICAL LABORATORY EXECUTIVES COMMITED one of the largest corporate fraud schemes in the past century. Reading the federal indictments against Elizabeth Holmes and Ramesh “Sunny” Balwani unsealed Friday provides insights into the extensive scale and wide scope of the a…

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Holmes, Balwani Indicted by Department of Justice

CEO SUMMARY: Federal criminal indictments were unsealed last Friday in San Francisco against Elizabeth Holmes and Ramesh “Sunny” Balwani for their actions as executives at Theranos, Inc., the once high-flying lab test company. Officials at the Department of Justice said the counts aga…

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Hospital Lab Outreach Still Effective Revenue Strategy

CEO SUMMARY: Despite the challenges hospital and health system laboratory outreach programs face today, there are many ways they can remain viable, according to an outreach expert from Mayo Medical Laboratories. By taking specific steps to increase volume and the value they provide, lab o…

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Inconsistent Billing Causes Patients to Find New Providers

THERE IS A NEW SOURCE OF LOST BUSINESS for physicians, clinical laboratories, and others. Patients are losing patience with confusing bills from their providers and opting to find new providers who offer simple, clear, and consistent bills. This turnover in patients was one key finding in a recently-…

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Near Real-time Data Helps Lab Save $500K Annually

CEO SUMMARY: After hospital labs and pathology groups implement Lean and process improvement methods to harvest the easiest cost savings and boost quality, they often take the next step of introducing real-time analytics systems. Access to detailed data about workflows, productivity, and …

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Big Insurers Seek Value-Based Deals with LabCorp, Quest

IT’S THE END OF AN ERA for the strategy of being the exclusive national lab provider for a major health insurer. Last week, the two largest clinical laboratory companies announced that the 10-year-old exclusive lab testing deals each had with a different big health insurer had crumbled. In 2007, …

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