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MolDx

Optum to Offer Laboratory Benefits Management to other Health Plans

This is an excerpt of a 1,355-word article in the June 21, 2022 issue of  THE DARK REPORT. The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: UnitedHealth Group subsidiary Optum announced a new laboratory benefits management program aimed at impr…

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UnitedHealth’s Optum to Offer Lab Test Management

CEO SUMMARY: UnitedHealth Group subsidiary Optum announced a new laboratory benefits management program aimed at improving utilization of genetic/molecular clinical laboratory testing. The goal is to save health plans money while bringing genetic test validity data prominently into …

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How Labs Can Add Value for Providers, Insurers, Pharma

CEO SUMMARY: For pathologists and clinical, molecular, and genetic testing labs, appropriate reuses of lab data can provide a new source of revenue. Labs that serve as preferred providers of diagnostic testing data can help health systems, ordering physicians, pharmaceutical companies, an…

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Labs Get High Denial Rates Under New NCCI Rules

CEO SUMMARY: Under guidelines the National Correct Coding Initiative issued last year, many clinical laboratories are not getting paid for some tests. The rates of denial for labs running mostly molecular tests could range from 40% to 100% of revenue, one billing expert said. Implemented …

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May 29, 2018 Intelligence: Late Breaking Lab News

Ireland is dealing with a cervical cancer screening scandal that reaches back to laboratories in the United States. In recent months, the Irish public has learned that more than 200 women wrongly got negative Pap test results over a multi-year period. Many of these women did not learn of the erroneo…

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May 7, 2018 Intelligence: Late Breaking Lab News

In Sebastopol, Calif., the financially-troubled Sonoma West Medical Center (SWMC) dropped a controversial drugs-of-abuse testing program. The following month, without the revenue from the drug testing program, 37-bed SWMC lost $1.4 million. In 2017, the hospital entered into a pass-t…

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Palmetto GBA Issues Guidance On Billing NGS Test Panels

CEO SUMMARY: Across the lab industry, next generation sequencing is taking hold as an effective and efficient testing platform. In response, payers are developing coding and payment policies that may affect the finances of clinical labs. Last month, Palmetto GBA, a Medicare contractor, is…

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Payers Using Two Approaches To Price Molecular, Genetic Tests

PRIVATE PAYERS AND MEDICARE contractors are taking divergent approaches to establishing coverage policies and setting prices for molecular and genetic tests. That’s what Kuo Bianchini Tong, MS, CEO of Quorum Consulting Inc., sees happening. “One approach seeks to recognize the c…

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State of Clinical Lab Industry Likely to Be Mixed in 2016

CEO SUMMARY: Over the next 24 months, it will be essential for every clinical laboratory and anatomic pathology group to develop clinical and financial strategies that meet the changing needs of health insurers, hospitals and health systems, physicians, and patients. THE DARK REPORT provi…

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Some Labs Report Faster Pay for Molecular, Genetic Tests

DURING RECENT MONTHS, some labs are reporting improvement in how their claims for certain molecular and genetic tests are being reimbursed. This is progress from the financial crises experienced during 2013 for many labs performing molecular and genetic tests….

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