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medicaid managed care

Nine Lab Groups Say New NCCI Policy Is Inconsistent

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…

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Labs Have Heavy Burden to Report Lab Price Data

CEO SUMMARY: Clinical labs must assess their responsibilities to report lab test market prices to CMS as part of the Protecting Access to Medicare Act. A panel of three experts took up this topic at a recent webinar hosted by THE DARK REPORT. On June 23, the federal Centers for Medicaid &…

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PAMA Final Rule Issued, CMS Plans to Cut Rates by 5.6%

CEO SUMMARY: CMS issued its final rule for implementing the laboratory payment reform included in the Protecting Access to Medicare Act of 2014 (PAMA) on June 17. All labs will see significant reductions to the Medicare Part B Clinical Laboratory Fee Schedule that becomes effective on Jan…

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New Federal Law Changes How CMS Sets Lab Prices

CEO SUMMARY: CMS wanted more power to cut the prices it pays for clinical lab testing. A significant part of the lab industry wanted more transparency and consistency in how CMS established coverage guidelines and prices for new lab tests. Congress appears to have attempted to craft a law…

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TennCare’s Collapse and Its Lessons for Labs

HOW MANY OF YOU HAVE HEARD ABOUT THE IMPENDING COLLAPSE of TennCare, the radical Medicaid experiment launched by Tennessee in 1994? It now consumes one-third of the Tennessee state budget and Governor Phil Bredesen announced that the program will probably be ended. It is likely that …

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“Free Testing” Strategy Stirs the Pot in Tenn.

CEO SUMMARY: In Tennessee, the state’s Medicaid HMO plan has been at odds with Quest Diagnostics Incorporated, which is using the “free testing” strategy to expand its share of the market. In recent months, TennCare Select has taken active steps to insure its physicians understand tha…

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“Waiver of Charges”: What Makes It Work

CEO SUMMARY: Little-used in the 1990s, when laboratory test ordering and billing practices were under intense scrutiny by federal regulators, the strategy of “free testing” is popping up in more regions around the country. To comply with compliance guidelines, labs using this strategy g…

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“May 4, 1998 Intelligence: Late Breaking Lab News”

Sales and marketing of laboratory services to physician offices is still feasible and cost-effective… if the effort is professionally managed and supported. Recently THE DARK REPORT was invited to speak at the national sales meeting of a public laboratory. Awards for 1997 sales production demonstra…

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“June 23, 1997 Intelligence: Late Breaking Lab News”

Joint Venture Hospital Laboratory network (JVHL) of Detroit added a not her hospital system to its growing regional laboratory network. M-Labs, the laboratory division of the University of Michigan Health System, joined JVHL. This is the eighth hospi…

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