TAG:

Medicare

Is Health Price Transparency at Its Tipping Point?

Is it a coincidence that a number of uninsured consumers filed separate lawsuits in federal courts against Laboratory Corporation of America and Quest Diagnostics—alleging, in both cases, that they were overcharged for clinical…

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November 25 2019 intelligence late breaking lab news

Medicare lab test price cuts mandated by the Protecting Access to Medicare Act (PAMA) are eroding the finances of urology groups that do in-office clinical laboratory testing. In the November issue of Urology Times, urologist Robert A. Dowling, MD, wrote a news story that identified the cut…

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Details Emerge in KU Hospital Misdiagnosis by Pathology Chair

AFTER A PATIENT FILED A LAWSUIT against a pathologist at the University of Kansas Hospital for fraud and negligence in a case stemming from a misdiagnosis of cancer in 2015, details about a settlement in the case were sealed. Now, some details have come out. Last month, NPR statio…

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Labs May Be Excluded from Revised Stark, AKS Rules

CEO SUMMARY: When CMS and the OIG issued proposed rules last fall to make it easier for providers to participate in value-based and coordinated care arrangements, they considered excluding clinical labs, pharma companies, and DME firms because of concerns that the proposed rules could pro…

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Labs May Be Excluded from Revised Stark Law, AKS Rules

This is an excerpt of a 1,460-word article in the Jan. 6, 2020 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: Here are early insights about a federal compliance reform that has not gotten much attention among clinical la…

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In LabCorp Case, Judge Upholds Some Claim

CEO SUMMARY: In a federal lawsuit against Laboratory Corporation of America, plaintiffs who were uninsured or underinsured charged the lab company with engaging in “business practices that trick and harass customers into paying excessive prices.” Plaintiffs made this and other claims …

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Lawsuits Allege LabCorp, Quest Overcharged Uninsured Patients

CEO SUMMARY: Court documents filed in U.S. District courts in New Jersey and North Carolina provide details about how each of the two lab companies set lab test prices differently—as much as 10 times higher—for cash-paying patients than for patients who have Medicare, Medicaid, or com…

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Lab Benefit Managers Want to Help Health Plans

CEO SUMMARY: Laboratory benefit management companies that offer a range of services to health insurers are gaining influence over clinical lab testing in important ways. On behalf of health insurers, LBMs will select labs for a payer’s network, then manage that network. They also manage…

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ICD-10 Gives Payers More Data About Lab Claims

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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Prediction of ICD-10 as Negative for Labs Comes True

IMPLEMENTATION OF ICD-10 DIAGNOSIS CODES in the United States happened on Oct. 1, 2015. At that time, a national laboratory association predicted that use of ICD-10 codes would cause Medicare Administrative Contractors (MACs) to pay labs less often and with lower reimbursement. The Dark Report ag…

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