managed care contracts Archives - The Dark Intelligence Group

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managed care contracts

Useful Lessons for Labs That Report PAMA Data

By Joseph Burns | From the Volume XXVI No. 2 – February 4, 2019 Issue

CEO SUMMARY: Will clinical labs heed the lessons learned from the first PAMA private payer market price reporting cycle that CMS conducted in 2017? One major difference is that the definition of applicable laboratories now includes most hospital labs. This creates the opportunity for a la…

ProMedica, Sonic Form Lab Outreach Joint Venture

By Joseph Burns | From the Volume XXV No. 12 – August 20, 2018 Issue

CEO SUMMARY: Fast-growing ProMedica Health System of Toledo, Ohio, agreed to a laboratory joint venture with Sonic Healthcare USA. As lab budgets and prices for lab tests are squeezed downward, ProMedica sees opportunity to add volume to this new core lab facility to improve efficiency an…

New Aetna, UHC Contracts Create Openings for Labs

By Joseph Burns | From the Volume XXV No. 11 – July 30, 2018 Issue

CEO SUMMARY: New national lab contracts that LabCorp and Quest announced in May could disrupt the lab testing market in ways regional labs can exploit, experts said. Health plans entered these new contracts after realizing that the exclusive network contracts do not work, one lab consulta…

Rural Hospital Group Says Lab Billing Model Is Legal

By Joseph Burns | From the Volume XXV No. 10 – July 9, 2018 Issue

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 …

Rural Hospital Spokesman: Hospital Lab Outreach Programs Are Legal

By R. Lewis Dark | From the Volume XXV No. 10 – July 9, 2018 Issue

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…

Why Lab Companies Buy Bankrupt Rural Hospitals

By Joseph Burns | From the Volume XXV No. 8 – May 29, 2018 Issue

CEO SUMMARY: Seeking the higher lab-test payment rates that insurers pay hospital labs, some lab testing companies are buying rural, financially-struggling hospitals in what may be the latest twist on the pass-through billing strategy that certain lab testing firms have found to be lucrat…

Lab companies and bankrupt hospitals: Dancing around medical billing fraud

By R. Lewis Dark | From the Volume XXV No. 8 – May 29, 2018 Issue

This is an excerpt from a 2,000-word article in the May 29, 2018 issue of THE DARK REPORT. The complete article is to all readers as long as the article limit has not been reached, and always available to paid members of the Dark Intelligence Group. …

What Are Lab Industry’s True Major Issues?

By R. Lewis Dark | From the Volume XXV No. 7 – May 7, 2018 Issue

WE’VE JUST FINISHED A FASCINATING WEEK IN NEW ORLEANS, at the 23rd annual Executive War College. More than 820 lab leaders were present to hear 104 interesting speakers in 65 unique sessions. Collectively, this group represented as much as $20 billion in annual clinical lab and pathology r…

Fla. Lab Sells to Labcorp, But Keeps Nursing Homes

By Joseph Burns | From the Volume XXIV No. 16 – November 20, 2017 Issue

CEO SUMMARY: Vista Clinical Diagnostics of Clermont, Fla., is betting big on the nursing home sector just when many labs serving nursing homes are worried about steep Medicare cuts coming Jan. 1. After selling its physician office referral testing, 35 patient service centers, and a mobile…

New source of lab test abuse surfaces in the form of HOPDs and MSOs

By Mary Van Doren | From the Volume XXIV No. 15 – October 30, 2017 Issue

This is an excerpt from a 2,350-word article in the Oct. 30, 2017 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group. CEO SUMMARY: …

Volume XXVII No. 9 – June 22, 2020

THE NEWS ON THE SEROLOGICAL TEST FRONT is discouraging, even bleak, as THE DARK REPORT analyzes the outcome of the FDA’s own review of 11 tests previously listed as marketable. Only three tests passed the review, and yet a quality control expert consulted by THE DARK REPORT has dim views of the FDA’s testing operation, leading to even more doubts. Also, health insurers are scraping away at mandated COVID-19 test reimbursements, leaving lab revenues once again at their mercy.

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