ICD-10 Gives Payers More Data About Lab Claims

By Joseph Burns

CEO SUMMARY: Evidence shows that adoption of ICD-10 diagnosis codes in 2015 made it possible for health insurers to track clinical laboratory testing more closely, ask more questions about those tests, and deny coverage. Increased detail about each patient’s condition has led to increas…

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ICD-10 Codes Give Payers More Data About Lab Claims

By Mary Van Doren

This is an excerpt of a 1,484-word article in the Nov. 25, 2019 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: It’s an unreported trend tracked only by THE DARK REPORT, but which is essential reading for clinical …

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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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July 30, 2018 Intelligence: Late Breaking Lab News

By Robert Michel | From the Volume XXV No. 11 – July 30, 2018 Issue

Clinical labs and physicians can soon say goodbye to “meaningful use.” Federal officials are proposing a significant change to the Medicare and Medicaid EHR Incentive program for certified EHRs that has been in existence since 2011. In a press release issued last spring, the Centers for M…

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D.C. Circuit Court Reverses Medical Necessity Ruling

By Joseph Burns | From the Volume XXV No. 5 – March 26, 2018 Issue

MANY LAB EXECUTIVES were concerned last year after a judge in the District of Columbia Circuit Court ruled that clinical laboratories need to determine that all lab test services physicians order are medically necessary. The court also ruled that ordering physicians do not need to determine medical …

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Anthem Seeks $13.5M from California Hospital

By Joseph Burns | From the Volume XXV No. 4 – March 5, 2018 Issue

CEO SUMMARY: Anthem charged 37-bed Sonoma West Medical Center in Sebastopol, Calif., of engaging in an improper billing scheme to defraud Anthem and its affiliated Blue Cross and Blue Shield plans. In effect, the charge is a notification to SWMC that Anthem intends to sue SWMC and its…

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LAB BRIEFS

By Robert Michel | From the Volume XXV No. 4 – March 5, 2018 Issue

DUBAI TO TEST DNA OF ITS 3 MILLION CITIZENS RECENTLY, GOVERNMENT OFFICIALS in Dubai announced a plan to conduct genetic testing on all three million residents. Experts say this is an unprecedented decision by any national govern…

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Anthem accuses tiny hospital of pass-through billing scheme

By Mary Van Doren | From the Volume XXV No. 4 – March 5, 2018 Issue

This is an excerpt from a 1,300-word article in the March 5, 2018, 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…

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Lab Executives Declare Concerns about Fee Cuts

By Joseph Burns | From the Volume XXV No. 1 – January 2, 2018 Issue

CEO SUMMARY: Members of Joint Venture Hospital Laboratories in Michigan anticipate that the 2018 Clinical Laboratory Fee Schedule rates being implemented under PAMA will lower payment from Medicare to less than the cost of running tests, especially for rural and critical access hospitals….

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Pathologist’s Error and Hospital’s Cover-up Lead to CMS Investigation

By Joseph Burns | From the Volume XXIV No. 13 – September 18, 2017 Issue

CEO SUMMARY: In the latest chapter of an explosive case at the University of Kansas Medical Center that includes claims of a cancer misdiagnosis, an unnecessary surgery, and a cover-up that involves the former chair of pathology, the patient has sued for fraud, negligence, and civil consp…

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