OIG: Billing Code 81408 Is at ‘Risk of Improper Payment’

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

CEO SUMMARY: Clinical lab executives familiar with molecular test coding and billing will not be surprised to learn that billing code 81408—commonly used on genetic test claims—is at risk of fra…

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ACLA: NCCI Guidelines Are a ‘Step Backwards’

By Joseph Burns | From the Volume XXVI No. 6 – April 29, 2019 Issue

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…

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Labs Get High Denial Rates Under New NCCI Rules

By Joseph Burns | From the Volume XXVI No. 6 – April 29, 2019 Issue

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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Nine Lab Groups Say New NCCI Policy Is Inconsistent

By Joseph Burns | From the Volume XXVI No. 5 – April 8, 2019 Issue

CEO SUMMARY: By its name alone, the National Correct Coding Initiative (NCCI) Policy Manual implies that it will be accurate and consistent with other coding initiatives. But nine groups representing various clinical laboratories say NCCI guidelines that the federal Centers for Medicare a…

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U of Florida Health Improves Patient Care with PGx Testing

By Joseph Burns | From the Volume XXV No. 17 – December 3, 2018 Issue

CEO SUMMARY: Since 2011, the University of Florida Health System has used pharmacogenetic test (PGx) results to guide physicians when they prescribe certain drugs. This initiative has improved patient outcomes, reduced the overall cost per episode of care, and gained partial reimbursemen…

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GE Healthcare Sells Omnyx to Inspirata

By Joseph Burns | From the Volume XXV No. 3 – February 12, 2018 Issue

CEO SUMMARY: Now that the FDA has cleared a digital pathology for use in primary diagnosis, interest in DP is building. Inspirata purchased Omnyx and its assets because the Omnyx Dynamyx digital pathology software has strong features that could be integrated into Inspirata’s digital pat…

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In Florida, More Tests Added to UHC’s Decision-Support Program

By Joseph Burns | From the Volume XXV No. 1 – January 2, 2018 Issue

IN THE FIRST BROAD EXPANSION OF ITS pilot decision-support program for clinical lab testing in Florida, UnitedHealthcare (UHC) will add genetic and molecular tests, drug tests, and pathology procedures, among other assays starting in two months. On March 1, UHC will expand its labor…

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Value of Miraca Falls By 92% from 2011 to 2017

By Joseph Burns | From the Volume XXIV No. 17 – December 11, 2017 Issue

CEO SUMMARY: Miraca Life Sciences amended its merger agreement with Avista Capital Partners after the lab lost value in the two months since the agreement was signed in September. Factors precipitating the revision were a significant decline in reimbursement rates, stiff competition from …

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UnitedHealth to Start Gene Test Pre-Approval

By Joseph Burns | From the Volume XXIV No. 12 – August 28, 2017 Issue

CEO SUMMARY: With programs now at the nation’s two largest insurers, is it possible to argue that prior-authorization is going mainstream? Some observers say, yes, as THE DARK REPORT predicted. What is certain is that starting Nov. 1, UnitedHealthcare is requiring prior authorization fo…

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2014’s PAMA Fix Comes Back to Haunt Big Labs

By R. Lewis Dark | From the Volume XXIV No. 11 – August 7, 2017 Issue

AS YOU READ THE INTELLIGENCE BRIEFINGS IN THIS ISSUE about lab industry efforts to convince Congress, the administration, and the new leaders of the Centers for Medicare and Medicaid Services to delay implementation of the PAMA final rule on market price reporting, keep in mind that�…

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