CEO SUMMARY: By its name alone, the National Correct Coding Initiative (NCCI) Policy Manual implies that it will be accurate and consistent with other coding initiatives. But nine groups representing various clinical laboratories say NCCI guidelines that the federal Centers for Medicare and Medicaid Services issued in December and implemented on Jan. 1 are inconsistent
Tag: laboratory service
CEO SUMMARY: Almost half of the nation’s hospitals and health systems are rethinking how to use their clinical labs to support clinical and financial strategies. Options range from outright sale of their lab outreach businesses to lab management agreements or joint ventures with one of the nation’s three billion-dollar public lab companies. Each of the
CEO SUMMARY: Pass-through billing arrangements, particularly those involving clinical laboratory tests, have long been recognized by healthcare attorneys as having great potential to violate certain federal and state laws. Despite this fact, board members of a financially-struggling community hospital went forward with a pass-through billing agreement that news accounts says committed the hospital to pay
This is an article from the Dec. 11, 2017 issue of THE DARK REPORT. The complete article is available for a limited time to all readers. This article plus a full analysis of 2017 developments in the PAMA process are available at all times to paid members of the Dark Intelligence Group.
IT’S A LONG-AWAITED DEVELOPMENT!
CEO SUMMARY: In September, Aetna filed a lawsuit in Pennsylvania accusing 14 defendants—including a hospital, a hospital management company, eight lab companies or lab management companies, two physicians, and two individuals—of defrauding Aetna, its client employers, and its members. The lawsuit is an example of a lab test arrangement in which independent lab companies and
IT’S A LONG-AWAITED DEVELOPMENT! Today, a federal lawsuit was filed against the Department of Health and Human Services (HHS) by the American Clinical Laboratory Association (ACLA).
The lab association is asking a federal judge to review specific actions taken by the Centers for Medicare and Medicaid Services in how it is implementing sections of the Protecting
MIXED IN THE BAD NEWS concerning the proposed Clinical Laboratory Fee Schedule for 2018, there is some good news regarding what the federal Centers for Medicare and Medicaid Services proposes to pay for certain advanced diagnostic tests.
After analyzing the proposed fee schedule, Quorum Consulting of San Francisco, reported, as other analysts have concluded, that CMS
CEO SUMMARY: Management companies using a new generation of potentially fraudulent schemes are targeting hospitals and health systems for arrangements that use questionable means to increase lab test volume and revenue. The management companies often use the term “hospital outpatient department (HOPD) billing model” to describe these arrangements. The scammers want the hospitals, as in-network
CEO SUMMARY: Some lab companies may be prepared to challenge in court the methodology CMS used in setting the requirements of the Protecting Access to Medicare Act of 2014 to conduct a study of private payer market prices for lab tests and use that data to propose new prices for the Part B Clinical Laboratory
FOR THE LAB INDUSTRY, THE FEE CUTS proposed in the 2018 Clinical Laboratory Fee Schedule would be even more aggressive than what the federal Centers for Medicare and Medicaid Services had earlier predicted for Medicare Part B.
In the days following the Sept. 22 publication of the proposed fee schedule, major lab industry associations issued statements