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…

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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…

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For Labs, Blockchain Offers New Opportunities

By Joseph Burns | From the Volume XXVI No. 3 – February 25, 2019 Issue

CEO SUMMARY: Some of blockchain’s proponents view its potential uses in health information technology to combat cybersecurity threats and improve the secure exchange of health information through electronic medical record systems. But for clinical laboratories, blockchain could be the k…

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Anthem Alleges $16M in Calif. Hospital Lab Fraud

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

CEO SUMMARY: In a lawsuit filed in the U.S. District Court for the Central District of California, Anthem and affiliated Blue Cross Blue Shield plans alleged that 37-bed Sonoma West Medical Center, a Florida lab testing company, a medical billing company, and others used a pass-through la…

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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…

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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. …

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Cigna Sues HDL, Alleges Unlawful Fee Scheme

By Joseph Burns | From the Volume XXI No. 15 – November 3, 2014 Issue

CEO SUMMARY: In court papers, Cigna alleged that HDL misrepresented patients’ responsibilities by promising not to collect co-payments, co-insurance, or deductibles. Also, HDL promised not to seek reimbursement from patients for any portion of its bills that the health insurer did not c…

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May 28, 2013 “Intelligence: Late Breaking Lab News””

By Robert Michel | From the Volume XX No. 7 – May 28, 2013 Issue

Globalization of laboratory medicine continues to move forward. Two recent examples illustrate this trend. Earlier this month, the University of Pittsburgh Medical Center (UPMC) announced that it had entered into an agreement with the Citizens Hospital of Hyderabad, …

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NPI Rules Slow Payments to Pathology Groups, Labs

By Robert Michel | From the Volume XV No. 8 – June 16, 2008 Issue

CEO SUMMARY: New rules requiring use of National Provider Identification (NPI) numbers took effect on May 23. Since then, Medicare carriers and payers nationwide have rejected claims from pathologists and other providers that do not comply with the new NPI rules. A missing NPI on just one…

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Pumping Up Performance of Lab Billing & Collections

By Robert Michel | From the Volume XIV No. 4 – March 12, 2007 Issue

CEO SUMMARY: Coding, billing, collections, and compliance continue to grow in complexity, making management of the lab’s revenue cycle ever more difficult. One by one, a number of the nation’s largest laboratories are taking steps to automate management of their revenue cycle by utili…

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