This is a synopsis of three in-depth articles in the Aug. 12, 2019 issue of THE DARK REPORT (TDR). The full articles are available to members of The Dark Intelligence Group.
CEO SUMMARY: In 2017, an auditor for CMS alleged that True Health Diagnostics filed fraudulent claims and the federal Medicare program cut all payments to
Tag: lab tests
ACLA Gets Procedural Win in Its Appeal of PAMA Case
By Joseph Burns, from the Volume XXVI No. 11 – August 12, 2019 issue
IN A SIGNIFICANT WIN for the American Clinical Laboratory Association (ACLA) and other groups suing federal Department of Health and Human Services (HHS), the U.S. Court of Appeals for the District of Columbia ruled in the ACLA’s favor on July 30.
Ruling on the appeal in the case the ACLA brought against HHS Secretary Alex Azar
After Two-Year Battle with CMS, True Health on Verge of Collapse
By Robert Michel, from the Volume XXVI No. 11 – August 12, 2019 issue
CEO SUMMARY: In 2017, an auditor for CMS alleged that True Health filed fraudulent claims and the federal Medicare program cut all payments to the lab company and one month later reduced the cut to 35% of the billed amount. Two months ago, CMS ended all payments again. These facts became public on July 2
How Lab Fraud Hurts Hospital Labs, Pathologists
By R. Lewis Dark, from the Volume XXVI No. 11 – August 12, 2019 issue
ONCE AGAIN, A HIGH-PROFILE LAB COMPANY faces allegations of fraud and abuse. This time it is True Health Diagnostics of Frisco, Texas. Details of this case were revealed last month when True Health filed a lawsuit in a federal court in Texas against the agencies running the federal Medicare program.
In its lawsuit, True Health denies
Aetna Ends Payment for Professional Component
By Joseph Burns, from the Volume XXVI No. 9 – July 1, 2019 issue
CEO SUMMARY: As of Aug. 1, Aetna will stop paying out-of-network pathologists for the professional component review of certain clinical pathology tests. Until now, the health insurer has paid for the professional component when out-of-network labs billed for clinical lab tests using the modifier 26. In a notice to labs, Aetna said it will pay
May 20, 2019 Intelligence: Late Breaking Lab News
By Robert Michel, from the Volume XXVI No. 7 – May 20, 2019 issue
Canada faces a similar shortage of medical technologists (MTs) as exists in the United States. “We have reached the point now where some laboratories have been closed for weeks due to insufficient staffing, which is a cascading problem for patients and the healthcare system,” stated Maria Klement, President of the Canadian Society for Medical Laboratory
What Labs Can Expect from PAMA in 2019
By Joseph Burns, from the Volume XXVI No. 7 – May 20, 2019 issue
CEO SUMMARY: Attendees at the Executive War College learned that CMS has taken steps to expand the number of hospital labs required to report their private payer lab test price data under the Protecting Access to Medicare Act, but the unbundling of certain test panels could be problematic. Problems can occur when labs either did
The Bad News: Disruption. The Good News: Opportunity!
By Robert Michel, from the Volume XXVI No. 7 – May 20, 2019 issue
CEO SUMMARY: There was an interesting consensus that emerged from the 80 sessions and 118 speakers at this year’s Executive War College in New Orleans earlier this month. The consensus centered around two themes. One theme is disruption, which is bad news for those labs that hope to maintain the status quo. The other theme
ACLA: NCCI Guidelines Are a ‘Step Backwards’
By Joseph Burns, from the Volume XXVI No. 6 – April 29, 2019 issue
CEO SUMMARY: In a letter to the National Correct Coding Initiative, the American Clinical Laboratory Association (ACLA) raised significant concerns about new language in the policy manuals for Medicare and Medicaid. ACLA said the new NCCI guidelines for molecular and other tests requiring multiple steps for one specimen reduce transparency, increase the administrative burden on
Labs Get High Denial Rates Under New NCCI Rules
By Joseph Burns, from the Volume XXVI No. 6 – April 29, 2019 issue
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