managed care Archives - The Dark Intelligence Group

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2019’s Top 10 Lab Stories Reveal Major Laboratory Industry Trends

This is an excerpt of a 3,163-word article in the Dec. 16, 2019 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: There was plenty of bad news in 2019 for clinical labs and pathology groups. Yet lurking inside this new…

How Labs Can Add Value for Providers, Insurers, Pharma

By Joseph Burns | From the Volume XXVI No. 15 – November 4, 2019 Issue

CEO SUMMARY: For pathologists and clinical, molecular, and genetic testing labs, appropriate reuses of lab data can provide a new source of revenue. Labs that serve as preferred providers of diagnostic testing data can help health systems, ordering physicians, pharmaceutical companies, an…

Anthem’s Cuts in AP Fees Could Put Patients at Risk

By Joseph Burns | From the Volume XXVI No. 12 – September 3, 2019 Issue

CEO SUMMARY: Consultants who work with anatomic pathologists have several theories about why Anthem is enacting deep cuts of 50% to 70% for the professional component of many anatomic pathology services. While they have different ideas about what motivates the nation’s second largest he…

Anthem Rolling Out More Anatomic Path Price Cuts

By Joseph Burns | From the Volume XXVI No. 9 – July 1, 2019 Issue

CEO SUMMARY: Anthem is making big changes to its relationships with anatomic pathology groups. Getting most of the attention at the moment are the insurer’s letters announcing price cuts for anatomic pathology services of 50% to 70% of Medicare fees. But another major change may also tr…

Anthem Rolling Out New Pathology CPT Code Cuts

By Mary Van Doren | From the Volume XXVI No. 9 – July 1, 2019 Issue

This is a synopsis of a 2,120-word article in the July 1, 2019 issue of THE DARK REPORT (TDR). The full articles are available to members of The Dark Intelligence Group. CEO SUMMARY: Anthem is making big changes to its relationships with anatomic pathology (AP) groups. Getting most o…

Nine Lab Groups Say New NCCI Policy Is Inconsistent

By Joseph Burns | From the Volume XXVI No. 5 – April 8, 2019 Issue

CEO SUMMARY: By its name alone, the National Correct Coding Initiative (NCCI) Policy Manual implies that it will be accurate and consistent with other coding initiatives. But nine groups representing various clinical laboratories say NCCI guidelines that the federal Centers for Medicare a…

Fla. Blue Cross Contract May Be Next Battleground

By Joseph Burns | From the Volume XXVI No. 4 – March 18, 2019 Issue

CEO SUMMARY: In Florida, the Blue Cross Blue Shield contract is coming up for renewal and the question is whether it will renew as exclusive to one national lab company. But Florida is not the only state where BCBS plans are planning to issue new contracts. Among the Blues plans that may …

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…

Lower Prices, More Data in UHC’s New Lab Network?

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

CEO SUMMARY: It’s been a common strategy among managed care payers to seek the lowest prices for clinical laboratory testing when negotiating contracts with labs. However, lower prices may become less important over time as the health system moves away from fee-for-service payment towar…

UnitedHealth Rumored to Be Excluding Labs from Its Network

By Robert Michel | From the Volume XXV No. 17 – December 3, 2018 Issue

IN RECENT DAYS, RUMORS HAVE SURFACED that UnitedHealthcare has begun to terminate the contracts it holds with a number of regional and non-national clinical laboratories. This news surfaced just as The Dark Report went to press. Given its importance to the clinical laboratory indust…

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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