Labs Must Respond to New CMS Anti-Fraud Rule

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 b…

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AP Practices Cautioned to Focus on Expenses

By Joseph Burns | From the Volume XXVI No. 9 – July 1, 2019 Issue

CEO SUMMARY: Reviewing an AP practice’s expenses is vitally important today when payers are cutting reimbursement. In the past, government and private payers paid more for the technical and professional components of anatomic pathology work, but those rates have eroded. While conversati…

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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…

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AP Groups Can Protect Revenue, Pathologist Compensation

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

CEO SUMMARY: Many anatomic pathology groups are watching their revenue decline and margins shrink on the same or greater case volume. These trends make it imperative to have a deeper understanding of the operational and financial variables that contribute to stability in the group’s fi…

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Wisconsin Provides Peek at Pathology’s Future

By R. Lewis Dark | From the Volume XXVI No. 3 – February 25, 2019 Issue

BIGGER PATHOLOGY GROUPS AND METROWIDE OR STATEWIDE COVERAGE will be major characteristics in the anatomic pathology profession as healthcare continues to transform in new ways. That is why the reasons for the substantial growth in case volume and revenue at North Shore Pathologists …

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Several Big Surprises in 2018’s Top 10 Lab Stories

By Robert Michel | From the Volume XXV No. 18 – December 24, 2018 Issue

CEO SUMMARY: This year’s list of the Top 10 Lab Industry Stories for 2018 is dominated by new directives from Medicare and private health insurers, as well as significant decisions by federal courts. Collectively, these developments create new compliance risks for all clinical laborator…

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2019 Outlook: Lab Industry Future Looks Dire, From Reactions to Recent Medicare Fraud Cases to PAMA Reporting and Other Stress Factors

By Mary Van Doren | From the Volume XXV No. 18 – December 24, 2018 Issue

CEO SUMMARY: This year’s list of the Top 10 Lab Industry Stories for 2018 is dominated by new directives from Medicare and private health insurers, as well as significant decisions by federal courts. Collectively, these developments create new compliance risks for all clinical laborator…

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Sonic to Pay $540 Million to Buy Aurora Diagnostics

By Joseph Burns | From the Volume XXV No. 18 – December 24, 2018 Issue

CEO SUMMARY: Sonic Healthcare, Ltd., announced that it would pay $540 million—a multiple of 9.2 times EBITDA—to acquire Aurora Diagnostics, the anatomic pathology company based in Palm Beach Gardens, Fla. Sonic will gain 32 pathology practice sites and add 220 pathologists to its netw…

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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. …

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Quest Acquires Two Labs, Two Other Health Firms

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

CEO SUMMARY: In the span of four days in September, Quest Diagnostics agreed to buy two lab companies and the lab testing service line of a third firm. In August, it purchased wellness company Provant Health, which had earlier filed a bankruptcy action. Each of these transactions helps Qu…

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