By Joseph Burns, from the Volume XXV No. 16 – November 13, 2018 issue
BUILDING ON THE LESSONS IT LEARNED by developing lab services that helped primary care physicians identify, diagnose, and treat diabetes patients in their practices, Sonic Healthcare USA was ready to do the same for another disease.
Sonic wanted to go beyond simply reporting an accurate and timely lab test result. Instead, it wanted to leverage the
By Joseph Burns, from the Volume XXV No. 16 – November 13, 2018 issue
CEO SUMMARY: In its work for a federally qualified health center, Sonic Healthcare USA helped physicians use a data-driven approach to population health management that incorporated integrated financial and clinical analytics. Also, Sonic developed technologies that give ordering physicians clinical decision support and targeted patient engagement tools. It then developed a way to contact patients
By Joseph Burns, from the Volume XXV No. 16 – November 13, 2018 issue
CEO SUMMARY: On Nov. 2, the federal Centers for Medicare and Medicaid Services released its Physician Fee Schedule for 2019. It says it will expand the number of labs from which it collects data about the lab test prices paid by private health insurers. While some labs may welcome these changes, groups representing clinical laboratories
By R. Lewis Dark, from the Volume XXV No. 16 – November 13, 2018 issue
How many consecutive 10% and 15% cuts to the prices Medicare pays for clinical laboratory tests can smaller community labs absorb before they are forced to shut their doors and go out of business? This nation is about to find out. As this happens, Medicare beneficiaries (and their physicians) in small towns and rural areas
By Joseph Burns, from the Volume XXV No. 14 – October 1, 2018 issue
CEO SUMMARY: While acknowledging that the American Clinical Laboratory Association raises important questions in its case against the federal Department of Health and Human Services, a district court judge ruled that the court cannot resolve the dispute and dismissed the ACLA’s claims for lack of “subject matter jurisdiction.” While not dismissing it outright, the judge
By Joseph Burns, from the Volume XXV No. 12 – August 20, 2018 issue
CEO SUMMARY: In a lawsuit filed in the U.S. District Court for the Central District of California, Anthem and affiliated Blue Cross Blue Shield plans alleged that 37-bed Sonoma West Medical Center, a Florida lab testing company, a medical billing company, and others used a pass-through lab test billing scheme to defraud Anthem and its
By maryv
CEO SUMMARY: Publication of the draft CMS Physician Fee Schedule on July 12 brought unwelcome news for the clinical lab industry, at least as it pertains to that perennial question: Should hospital lab outreach data be included in a PAMA market study? The federal Centers for Medicare and Medicaid Services must conduct a new market
By Joseph Burns, from the Volume XXV No. 11 – July 30, 2018 issue
CEO SUMMARY: Publication of the draft Medicare Physician Fee Schedule on July 12 brought unwelcome news for the clinical lab industry, at least as it pertains to whether hospital lab outreach data should be included in the PAMA market study that the federal Centers for Medicare and Medicaid Services must conduct. In the draft rule,
By maryv
CEO SUMMARY: As the debate grows more heated, supporters of hospital outpatient department (HOPD) billing schemes have ramped up their defense of the practice. The president of the National Association of Rural Hospitals tells THE DARK REPORT that rural hospitals are permitted to bill for hospital lab outreach program services under Medicare’s 70/30 shell rule.
By Joseph Burns, from the Volume XXV No. 10 – July 9, 2018 issue
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 other inpatient services.
Most rural hospitals
