This is an excerpt from a 1,485-word article in the June 5, 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: At a time when most molecular and genetic testing companies are
By Joseph Burns, from the Volume XXIV, No. 8 – June 5, 2017 issue
CEO SUMMARY: At a time when most molecular and genetic testing companies are struggling to gain coverage for their tests, this Silicon Valley-based lab company has become an in-network lab provider for a number of health insurers—including three of the nation’s largest payers. It did this by establishing a patient-friendly price of $249 for its
By R. Lewis Dark, from the Volume XXIV, No. 8 – June 5, 2017 issue
TODAY, THE LAB INDUSTRY FACES A CONTRADICTION when setting prices for individual lab tests. At one extreme, a certain sector of labs seeking to win exclusive managed care contracts sets high-volume routine test prices at or below the fully-loaded cost to perform those tests. At another extreme, laboratory companies with specialty molecular and genetic tests
By Robert Michel, from the Volume XXIV, No. 4 – March 13, 2017 issue
There’s bad news for clinical labs and pathology groups that lack the capability of collecting copays, deductibles, and out-of-pocket payments from patients at time of service. As of October, 2016, four out of every 10 Americans under the age of 65 with health insurance had a high-deductible health plan. That means these patients are responsible
By R. Lewis Dark, from the Volume XXIV, No. 2 – January 30, 2017 issue
WITH HEALTHCARE POISED TO MAKE FUNDAMENTAL CHANGES in both the delivery of care (think integration, ACOs, medical homes) and how providers are paid (less fee-for-service, more budgeted payment methods), it is time for the entire profession of laboratory medicine to tackle the elephant in the room: lab tests bought and sold as commodities.
The commoditization of
By Joseph Burns, from the Volume XXIV, No. 1 – January 9, 2017 issue
ONE WAY THAT A CLINICAL LAB can fight back against insurers who refuse to pay lab test claims is to sue them. That’s exactly what Medical Diagnostic Laboratories of Hamilton, N.J. is doing!
Not only has MDL filed lawsuits against two major health insurance companies, but in one lawsuit, it named a national lab company as
By Joseph Burns, from the Volume XXIV, No. 1 – January 9, 2017 issue
CEO SUMMARY: Among the three chief reasons for the merger of CellNetix and Puget Sound Institute of Pathology, the most compelling was the need to address the challenges in the current reimbursement environment and to prepare for reductions in payment to pathologists expected in the coming years under the Patient Access to Medicare Act. CellNetix
By R. Lewis Dark, from the Volume XXIII No. 17 – December 19, 2016 issue
BY NOW, NEARLY EVERY LAB MANAGER knows that Medicare lab test fee cuts will commence in just 13 months, on Jan. 1, 2018. The federal Centers for Medicare & Medicaid Services estimates that the final rule for PAMA private payer market price reporting will produce cuts of $5.4 billion over 10 years. (See TDRs, November
By Mary Van Doren, from the Volume XXIII, No. 16 - November 28, 2016 issue
This is an excerpt from a 2,700-word article in the November 28 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: THE DARK REPORT delivers the most detailed explanation ever offered of the payer-to-lab
By Joseph Burns, from the Volume XXIII, No. 16 - November 28, 2016 issue
CEO SUMMARY: In its work with more than 200 lab clients, XIFIN, Inc., of San Diego, sees the best and worst of problems in how labs submit claims to lab tests and how payers process these claims. In this exclusive interview, Lâle White, XIFIN’s Founder and CEO, identifies the systemic sources of problems in the
