Tag: Medicare

Northwell Health Lab Team Leverages Data to Add Value

CEO SUMMARY: Today, insurers get risk-adjusted payments for treating patients who have high-cost health conditions and they make risk-adjusted payments to physicians, hospitals, and other providers. At Northwell Health, the clinical lab saw the opportunity to leverage lab test data with other clinical and demographic data to identify patients who were undiagnosed or whose conditions were

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CMS, Lab Groups Begin Talks About Issues with NCCI Edits

SERIOUS PROBLEMS WITH THE NEW GUIDELINES for the National Correct Coding Initiative (NCCI) that were  implemented on Jan. 1 have caused nine clinical laboratory associations and groups to come together and voice their concerns to the federal Centers for Medicare and Medicaid Services (CMS).

CMS implemented those changes on Jan. 1, resulting in confusion among labs

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Improve Your AP Group’s Financial Performance

CEO SUMMARY: Across the nation, health insurers are paying less for anatomic pathology services. This shrinks pathology group revenue and reduces pathologist compensation. Savvy pathology groups are responding to this trend by reviewing long-standing processes in their coding, billing, and collections department. Their goal is to update these billing and collections processes in ways that

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PAMA Price Cuts Now Delivering One-Two Punch to Labs’ Revenue

WHEN DISCUSSING THEIR EARNINGS with Wall Street analysts in February, executives from both Laboratory Corporation of America (LabCorp) and Quest Diagnostics explained that the lab test price cuts from the Protecting Access to Medicare Act of 2014 (PAMA) were not only reducing revenue, but that many state Medicaid plans are following Medicare’s lead and cutting their

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ACLA: NCCI Guidelines Are a ‘Step Backwards’

CEO SUMMARY: In a letter to the National Correct Coding Initiative, the American Clinical Laboratory Association (ACLA) raised significant concerns about new language in the policy manuals for Medicare and Medicaid. ACLA said the new NCCI guidelines for molecular and other tests requiring multiple steps for one specimen reduce transparency, increase the administrative burden on

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