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Payers Are Right to Be Wary of Claims for Some LDTs’ Value
By Virchow | From the Volume XXX, Number 17 – December 4, 2023 Issue
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Private Health Insurers Are Aware of Problems with CPT Code 81408
By Virchow | From the Volume XXX, No. 13 – September 11, 2023 Issue
EDITOR’S NO…
UHC Will Delay Enforcement of Z-codes for Genetic Test Claims
By Scott Wallask | From the Volume XXX, No. 13 – September 11, 2023 Issue
IN THE LATEST BACKPEDAL ON ITS NEW POLICY, UNITEDHEALTHCARE (UHC) appears to have dropped its requirement for genetic testing laboratories to use Z-codes for claims under commercial health plans—for now. Earlie…
Smaller Labs Must Verify Z-code Arrangement with Lab Companies
By Virchow | From the Volume XXX, No. 12 – August 21, 2023 Issue
EDITOR’S NO…
OIG: Billing Code 81408 Is at ‘Risk of Improper Payment’
By Scott Wallask | From the Volume XXX, No. 11 – July 31, 2023 Issue
CEO SUMMARY: Clinical lab executives familiar with molecular test coding and billing will not be surprised to learn that billing code 81408—commonly used on genetic test claims—is at risk of fra…
Optum and Avalon Discuss Genetic Test Claims Review
By Scott Wallask | From the Volume XXX, No. 9 – June 19, 2023 Issue
CEO SUMMARY: With the ever-increasing number of genetic tests on the market, payers are understandably frustrated with genetic test claims that don’t clearly outline the medical need for a procedure or it…
Expect More Z-code Requirements for Genetic Tests
By R. Lewis Dark | From the Volume XXX, No. 9 – June 19, 2023 Issue
GENETIC TESTING COMPANIES ARE STILL REACTING TO LAST MONTH’S NEWS that one of the nation’s largest health insurers—UnitedHealthcare (UHC)—will require Z-codes for molecular test claims submitte…
UHC’s Z-Code Requirement to Commence on Aug. 1
By Scott Wallask | From the Volume XXX, No. 8 – May 30, 2023 Issue
CEO SUMMARY: In what may be an alarming development for certain clinical laboratories, as of Aug. 1, UnitedHealthcare will require Z-codes for molecular test claims filed under its co…
Attorney Advises Labs to Track Genetic Test LCDs
By Scott Wallask | From the Volume XXIX, No. 13 – September 19, 2022 Issue
CEO SUMMARY: Skyrocketing numbers of genetic test referrals and telehealth claims since 2016 are getting the full attention of both federal prosecutors and auditors from Medicare and private health insurers. The DOJ has filed criminal cases against a growing number of telehealth pro…
Optum to Offer Laboratory Benefits Management to other Health Plans
By Robert Michel | From the Volume XXIX, Number 9 – June 27, 2022 Issue
This is an excerpt of a 1,355-word article in the June 21, 2022 issue of THE DARK REPORT. The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: UnitedHealth Group subsidiary Optum announced a new laboratory benefits management program aimed at impr…
CURRENT ISSUE
Volume XXXI, No. 3 – February 26, 2024
A “perfect storm” of new developments in the clinical laboratory and pathology group industry is coming, and The Dark Report is analyzing these changes as well as preparing to present the details to attendees at the annual Executive War College. Also, HHS has published an important final rule for health IT Interoperability.
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