By Joseph Burns, from the Volume XXVI No. 15 – November 4, 2019 issue
CEO SUMMARY: One big development affecting the health insurance business is how four of the nation’s largest health insurers are diversifying in significant ways. Last spring, a healthcare strategist explained how each of these companies has spent billions of dollars in recent years to acquire other healthcare companies that are not part of the traditional
By Joseph Burns, from the Volume XXVI No. 15 – November 4, 2019 issue
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, and other organizations when they reuse lab test data to support evidence-based care and
By Joseph Burns, from the Volume XXVI No. 15 – November 4, 2019 issue
CEO SUMMARY: For all healthcare providers—including clinical laboratories and pathology groups—a new rule became effective this month. The rule allows Medicare to revoke or deny enrollment if a provider or supplier’s affiliates pose an undue risk of fraud. Lawyers familiar with the “Program Integrity Enhancements to the Provider Enrollment Process” rule are concerned about its
By R. Lewis Dark, from the Volume XXVI No. 15 – November 4, 2019 issue
THERE IS AN OFT-REPEATED ADAGE THAT what the government gives you with one hand, it takes away with the other. This may be an apt description of the new Medicare final rule that takes effect today, called the Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC).
The goal of the new rule is to give
This is an excerpt of a 2,882-word article in the Oct. 14, 2019 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group.
CEO SUMMARY: Four trends are disrupting the nation’s healthcare system in ways that no one would have predicted just a few decades ago – including startling
By Joseph Burns, from the Volume XXVI No. 14 – October 14, 2019 issue
CEO SUMMARY: Four trends are disrupting the nation’s healthcare system in ways that no one would have predicted just a few decades ago. Ted Schwab, a healthcare strategist, described these trends during his keynote presentation at the 24th Annual Executive War College in May. His insights and predictions will help clinical laboratory directors and pathologists develop
By Joseph Burns, from the Volume XXVI No. 14 – October 14, 2019 issue
CEO SUMMARY: In September, Alverno Laboratories, one of the largest networks of regional laboratories in the Midwest, added two Chicago hospital laboratories and six other hospital labs from the AMITA Health system to its network. The additional AMITA Health facilities joined Alverno as a result of health system consolidation. The consolidation of hospitals into health
By Joseph Burns, from the Volume XXVI No. 14 – October 14, 2019 issue
CEO SUMMARY: Clinical labs and pathologists providing tests for patients in Medicare, Medicaid, or Children’s Health Insurance Program should become acquainted with new enrollment rules that go into effect Nov. 4. The new rules allow CMS to revoke or deny enrollment to help stop fraud before it occurs in the federal healthcare programs. CMS intends
By R. Lewis Dark, from the Volume XXVI No. 14 – October 14, 2019 issue
IS IT A COINCIDENCE THAT, IN THIS ISSUE OF THE DARK REPORT, we cover two related developments, both involving the federal government’s efforts to control healthcare fraud and abuse?
First, you’ll read about the new federal rule scheduled to take effect on Nov. 4. It gives federal healthcare investigators new powers to exclude individuals and organizations
By Joseph Burns, from the Volume XXVI No. 13 – September 23, 2019 issue
CEO SUMMARY: One association representing pathologists says new payment rates that Anthem, Inc., is introducing in 14 states do not cover the costs of performing anatomic pathology and clinical lab testing for the tests in question. Another association says the steep payment cuts threaten the viability of small and rural pathology groups. State-by-state, Anthem is
