TAG:
Medicare
Labs Face Powerful and Unwelcome Forces
OVER THE PAST 25 YEARS, THERE HAS BEEN WIDESPREAD RECOGNITION THAT HEALTHCARE IN THE UNITED STATES is on an unsustainable path. The obvious argument was that year-over-year increases in healthcare costs would eventually overcome the ability of employers (private health plans) and the government (Medi…
1999’s ‘To Err Is Human’ Still an Opportunity for Labs
NOT ONLY DID THE 1999 PUBLICATION OF ‘TO ERR IS HUMAN” trigger a wave of national news coverage about patient harm in hospitals, it also launched this nation’s healthcare system on a multi-decade journey to boost the quality of care, reduce medical errors, and increase the transparency of both pati…
June 27, 2022 Intelligence: Late-Breaking Lab News
Efforts to revise the much-criticized methods Medicare officials use to establish prices the government pays clinical laboratories under the Protecting Access to Medicare Act (PAMA) of 2014 got a boost last week. On June 22, a bipartisan bill to accomplish that was introduced in the U.S. Senate. The …
Federal Prosecutors Describe Illegal Lab Bribes to Physicians
PATHOLOGISTS AND CLINICAL LAB MANAGERS SHOULD WELCOME every federal prosecution of a physician who accepts illegal bribes and inducements in exchange for laboratory test referrals. If physicians understood that federal prosecutors would file criminal charges against them for this behavior, fewer doct…
Labs Should Be Cautious about ‘Surprising’ EKRA Ruling
CONFUSION ABOUT WHEN IT IS LEGAL UNDER TWO FEDERAL LAWS to pay commissions to sales reps based on volume and/or revenue has existed since the passage of the federal Eliminating Kickbacks in Recovery Act of 2018 (EKRA). Now, a district court judge in Hawaii has surprisingly ruled that payments of perc…
Florida Laboratory Owner Gets 82-Month Jail Term
CEO SUMMARY: Federal prosecutors are sending a clinical lab owner to federal prison for almost eight years. Hopefully, this is a sign that the Department of Justice (DOJ) is ready to use criminal indictments more frequently against lab owners, lab managers, and lab sales reps who vi…
Comment Period Closing on Federal Surprise Billing Rule
PATHOLOGY GROUPS AND CLINICAL LABS HAD UNTIL SEPTEMBER 7 to comment on an interim final rule that provides federal protections against surprise billing and limits out-of-network (OON) cost sharing under many of the circumstances in which surprise bills arise most frequently….
XIFIN to Open New Office in South Carolina for Lab Billing
SINCE FEBRUARY, THE TOTAL NUMBER OF PEOPLE VACCINATED grew steadily even as the number of tests for COVID-19 declined sharply in the United States. But overall test volume has remained steady at 130% of pre-pandemic levels, said Brian Kemp, Vice President of Revenue Cycle Operations for XIFIN,…
Palmetto GBA Tells Consultant to Take Down Test Price Data
CEO SUMMARY: Lawyers for Medicare contractor Palmetto GBA sent a cease and desist letter in September to a respected lab consultant, telling him to delete from his health policy blog a document containing Medicare genetic test price and coding data. In the letter, Quinn was directed…
Medicare COVID Test Coding May Become a ‘Logistical Nightmare’
STARTING JAN. 1, 2021, clinical laboratories performing COVID-19 tests using high-throughput systems for Medicare patients must comply with a complex new coding rule when submitting claims for these tests. The federal Centers for Med…
CURRENT ISSUE
Volume XXIX, No. 11 – August 8, 2022
This issue examines the challenges facing the nation’s hospitals, health systems, and clinical labs: unprecedented shortages of lab staff, nurses, and other professionals with inflation-fueled cost increases and deteriorating hospital finances. Also, the issue delivers a case study showing how Bryan Health in Nebraska expanded its lab outreach program to include direct-to-consumer tests.
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