TAG:

pathology cpt codes

2019’s Top 10 Lab Stories Reveal Major Laboratory Industry Trends

This is an excerpt of a 3,163-word article in the Dec. 16, 2019 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group. CEO SUMMARY: There was plenty of bad news in 2019 for clinical labs and pathology groups. Yet lurking inside this new…

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ASCP, CAP Ask Anthem to Roll Back Price Cuts

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…

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Anthem’s Cuts in AP Fees Could Put Patients at Risk

CEO SUMMARY: Consultants who work with anatomic pathologists have several theories about why Anthem is enacting deep cuts of 50% to 70% for the professional component of many anatomic pathology services. While they have different ideas about what motivates the nation’s second largest he…

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Aetna, Anthem to Pay Pathology Groups Less

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…

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Anthem Rolling Out New Pathology CPT Code Cuts

This is a synopsis of a 2,120-word article in the July 1, 2019 issue of THE DARK REPORT (TDR). The full articles are available to members of The Dark Intelligence Group.  CEO SUMMARY: Anthem is making big changes to its relationships with anatomic pathology (AP) groups. Getting most o…

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More AP Consolidation: Aurora Buys Two Groups

CEO SUMMARY: Seeing the changes overtaking pathology practices, Brazos Valley Pathology decided to sell two of its group practices to Aurora Diagnostics. Last month’s transaction was not designed to fix financial problems nor was it because of retiring pathologists. Rather, it …

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Much Uncertainty About Pay for Molecular Codes

CEO SUMMARY: Having gone unpaid since January 1 for the 114 new molecular CPT codes, many clinical labs and pathology groups have stopped running these tests or laid off staff. Some are considering closing their doors. Evidence indicates that certain Medicare contractors are deciding that…

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Price Cuts, Long Delays in Payment Are Expected

CEO SUMMARY: In addition to a steep cut in the 88305 CPT code, anatomic pathology laboratories can expect cuts in the payment from Medicare for molecular and prostate biopsy testing. Two national experts in lab billing and reimbursement warn labs to expect confusion in how both public and…

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Lab MUEs Reconsidered, CMS Changes Course

CEOSUMMARY: It may bear are moment of common sense. Last month, Medicare officials stated their intent to exclude clinical laboratory and anatomic pathology CPT codes from the “Phase One” implementation of Medically Unbelievable Edits (MUEs). It is a positive step, and comes in respon…

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CMS Defers MUE Edits Until After Jan. 1, 2007

CEO SUMMARY: Medicare officials have granted a temporary respite on the troubling proposal to institute service restrictions per patient on some 80 pathology CPT codes and 1,100 clinical laboratory codes. These proposals are part of a new round of Medically Unbelievable Edits (MUEs). CMS …

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