CMS Issues AI Guidance for Medicare Advantage

By Mary Van Doren | From the Volume XXXI, No. 3 – February 26, 2024 Issue

CEO SUMMARY: With its guidance on how Medicare Advantage plans should use artificial intelligence (AI) when making treatment decisions involving individual patients, the federal Centers for Medicare and Medicaid Services has opened one door in the coming debate on how the federal governme…

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Lab Data Crucial to Insurer Risk Adjustment Models

By Scott Wallask | From the Volume XXX, No. 13 – September 11, 2023 Issue

CEO SUMMARY: Payers who use risk adjustment models as part of Medicare Advantage need diagnostic data that helps them document ICD-10 diagnoses that earn them higher premium payments for sicker pat…

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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…

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Lab News Briefs: Joint Commission, Bon Secours, Anthem, Walmart

By Scott Wallask | From the Volume XXX, No. 13 – September 11, 2023 Issue

Joint Commission Looks at Cyberattacks The Joint Commission issued a Sentinel Event Alert for hospitals to address cyberattacks. The alert pr…

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Big Employers Sue Payers over Price Transparency

By Robert Michel | From the Volume XXX, No. 12 – August 21, 2023 Issue

CEO SUMMARY: Feeling they’ve been denied access by insurance companies to price data about medical claim payments, self-funded employer plans and unions are taking their health insurance companies…

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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…

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With Z-codes, Will Other Payers Follow UnitedHealthcare’s Lead?

By Virchow | From the Volume XXX, No. 11 – July 31, 2023 Issue

EDITOR’S NOT…

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UnitedHealthcare Policy Change Requires NPI Numbers on Medicare Advantage Claims

By Robert Michel | From the Volume XXX, No. 8 – May 30, 2023 Issue

ANOTHER NEW POLICY RECENTLY ANNOUNCED by UnitedHealthcare (UHC) sets a deadline for June 1, 2023, requiring clinical laboratories and other ancillary providers to include the …

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Coverage, Reimbursement Still Difficult for New Lab Tests

By Robert Michel | From the Volume XXIX, No. 11 – August 8, 2022 Issue

CEO SUMMARY: Bringing a new proprietary diagnostic test to market is an arduous process. It takes patience and planning to complete the journey from test development to payer reimbursement. This slow process stems from the fact that the healthcare reimbursement system is fragmented,…

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Intermountain Health Merges with SCL Health

By Robert Michel | From the Volume XXIX, No. 7 – May 16, 2022 Issue

CEO SUMMARY: Mergers and acquisitions involving large integrated delivery networks (IDNs) are not only reshaping the nation’s hospital industry. These transactions also transform the way hospitals organize their clinical laboratories. Last month’s merger of Intermountain Health …

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