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Medicare Administrative Contractor
Expect RESULTS Act Vote by End of the Year
By Scott Wallask | From the Volume XXXIII, No. 7 – May 26, 2026 Issue
CEO SUMMARY: Evidence at the 2026 Executive War College suggests a coming push in clinical lab advocacy, focusing on the RESULTS Act to establish a permanent, database-driven reimbursement model. Simultaneously, federal regulators have floated the idea of heightened scruti…
Payers Unleash AI to Dissect Outlier Billing Patterns
By Janette Wider | From the Volume XXXIII, No. 6 – May 04, 2026 Issue
Diagnostic laboratories can follow every clinical guideline, employ the most talented clinical lab professionals, and provide life-saving data to patients, yet still find themselves in the crosshairs of a federal or payer audit. The culprit is …
How Private Health Insurers May Respond to FDA LDT Regulation
By Virchow | From the Volume XXXI, No. 8 – June 10, 2024 Issue
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Successful Ransomware Attack Misses Lab Claims
By R. Lewis Dark | From the Volume XXXI, No. 4 – March 18, 2024 Issue
HAS ANYONE NOTICED THAT CYBERCRIMINALS ARE STEADILY INCREASING THE SCALE AND MAGNITUDE OF THEIR AT…
Payers Are Right to Be Wary of Claims for Some LDTs’ Value
By Virchow | From the Volume XXX, Number 17 – December 4, 2023 Issue
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Private Health Insurers Are Aware of Problems with CPT Code 81408
By Virchow | From the Volume XXX, No. 13 – September 11, 2023 Issue
EDITOR’S NO…
UHC Will Delay Enforcement of Z-codes for Genetic Test Claims
By Scott Wallask | From the Volume XXX, No. 13 – September 11, 2023 Issue
IN THE LATEST BACKPEDAL ON ITS NEW POLICY, UNITEDHEALTHCARE (UHC) appears to have dropped its requirement for genetic testing laboratories to use Z-codes for claims under commercial health plans—for now. Earlie…
Smaller Labs Must Verify Z-code Arrangement with Lab Companies
By Virchow | From the Volume XXX, No. 12 – August 21, 2023 Issue
EDITOR’S NO…
OIG: Billing Code 81408 Is at ‘Risk of Improper Payment’
By Scott Wallask | From the Volume XXX, No. 11 – July 31, 2023 Issue
CEO SUMMARY: Clinical lab executives familiar with molecular test coding and billing will not be surprised to learn that billing code 81408—commonly used on genetic test claims—is at risk of fra…
Optum and Avalon Discuss Genetic Test Claims Review
By Scott Wallask | From the Volume XXX, No. 9 – June 19, 2023 Issue
CEO SUMMARY: With the ever-increasing number of genetic tests on the market, payers are understandably frustrated with genetic test claims that don’t clearly outline the medical need for a procedure or it…
CURRENT ISSUE
Volume XXXIII, No. 9 – July, 2026
Newsmaker Interview with Revvity’s Yves Dubaquie > How Specialty Diagnostic Tests Connect with Lab Customers: In this exclusive Q&A, Revvity’s Yves Dubaquie provides details about the in vitro diagnostics company’s priorities, including developing specialty tests and reviewing its business in China. Dubaquie also explains why clinical laboratories may need to consider hiring more technology-savvy workers in the future as the complexity of instruments grows.
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