TAG:
managed care contracts
Useful Lessons for Labs That Report PAMA Data
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
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
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
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
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
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
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?
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
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
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: …
CURRENT ISSUE
Volume XXX, No. 8 – May 30, 2023
Much lies underneath the surface of UnitedHealthcare’s (UHC) new policy mandating Z-code use for molecular tests covered under its commercial health plans. This development, which creates headaches for many genetic testing companies, is analyzed in depth here. Also, one company shows how data analytics improves lab productivity and TAT.
See the full table of contentsHow Much Laboratory Business Intelligence Have You Missed?
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