Aetna, Anthem to Pay Pathology Groups Less

By R. Lewis Dark | From the Volume XXVI No. 9 – July 1, 2019 Issue

TWO OF THE NATION’S LARGER HEALTH INSURERS—AETNA AND ANTHEM— ARE CUTTING WHAT THEY PAY for the professional component of certain clinical and anatomic pathology codes. In its communications with pathology groups about this policy change, Aetna says it will no longer pay for most clinical laborat…

Read More

---

Improve Your AP Group’s Financial Performance

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

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, an…

Read More

---

Medicare Data Makes Pathology Prices Public

By Joseph Burns | From the Volume XXV No. 15 – October 22, 2018 Issue

CEO SUMMARY: Each year since 2015, Medicare officials have posted the prices charged by every physician. That now makes it possible for pathology group practices to conduct a price study of their region and state to learn how their group’s prices compare with other pathology providers. …

Read More

---

Four Labs and Billing Company Pay $140,000 Fine in HIPAA Case

By Robert Michel | From the Volume XX No. 1 – January 22, 2013 Issue

WHEN A BILLING SERVICE company disposes of patients’ lab test records, it should do so in compliance with federal and state privacy rules. That means all protected health information (PHI) should be shredded or incinerated. Four pathology groups in Massachusetts learned this lesson the hard way wh…

Read More

---

Labs Have Questions about Prostate Biopsy Policy

By Joseph Burns | From the Volume XIX No. 13 – September 17, 2012 Issue

CEO SUMMARY: How will pathology laboratories respond to the publication of revised policies in how laboratories should file Medicare Part B claims for prostate biopsies? Not only will there be a sharp drop in the reimbursement paid for a 12-core prostate biopsy, but labs may be at increas…

Read More

---

Changed Medicare Policy Adds to Regulatory Risk

By Joseph Burns | From the Volume XIX No. 13 – September 17, 2012 Issue

CEO SUMMARY: When Medicare’s National Correct Coding Initiative (NCCI) manual took effect on January 1, 2012, it contained a significant change in how prostate biopsy claims are to be coded. This change was widely overlooked by the pathology profession and even dismissed entirely for it…

Read More

---

Prostate Biopsy Claims Affected by Policy Change

By Joseph Burns | From the Volume XIX No. 12 – August 27, 2012 Issue

CEO SUMMARY: Quietly, with no fanfare and little advance public notice, the Medicare program is taking steps to change reimbursement policy for prostate biopsies. On August 7, 2012, Palmetto GBA adopted the new policy published on January 1, 2012, by the National Correct …

Read More

---

How Labs Should Comply With New Signature Rule

By Robert Michel | From the Volume XVIII No. 1 – January 18, 2011 Issue

CEO SUMMARY: Across the nation, clinical laboratories and pathology groups are reacting to the new Medicare rule that requires a physician signature on a paper requisition for clinical laboratory tests. Laboratories using paper requisitions will need to add a signature line, then…

Read More

---

Pathology Records Found At Massachusetts Dump

By Robert Michel | From the Volume XVII No. 12 – August 23, 2010 Issue

CEO SUMMARY: Pathologists at four Massachusetts hospitals got a powerful reminder recently that a breach of protected health information (PHI) can occur at any time for the most unexpected reason. Earlier this month, the Boston Globe reported that the pathology reports and patien…

Read More

---

Clarient, Generation Health, GenMark, Osmetech, Laboratoire Cerba, UCLA Med Center

By Robert Michel | From the Volume XVII No. 9 – June 21, 2010 Issue

CLARIENT INKS PACT WITH GENERATION HEALTH FOR GENETIC TESTING PAYER PRE-AUTHORIZATION OF GENETIC TESTS is the reason for the newly-announced contract between Clarient, Inc., and Generation Health, Inc., of Upper Saddle River, New Jersey. An…

Read More

---