CEO SUMMARY: Attendees at the Executive War College learned that CMS has taken steps to expand the number of hospital labs required to report their private payer lab test price data under the Protecting Access to Medicare Act, but the unbundling of certain test panels could be problematic. Problems can occur when labs either did
Tag: procedure code
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 Jan. 1, the guidelines apply to labs running tests in
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 and Medicaid Services issued in December and implemented on Jan. 1 are inconsistent
This is an excerpt from a 2,700-word article in the November 28 issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group.
CEO SUMMARY: THE DARK REPORT delivers the most detailed explanation ever offered of the payer-to-lab
CEO SUMMARY: In its work with more than 200 lab clients, XIFIN, Inc., of San Diego, sees the best and worst of problems in how labs submit claims to lab tests and how payers process these claims. In this exclusive interview, Lâle White, XIFIN’s Founder and CEO, identifies the systemic sources of problems in the
CEO SUMMARY: One common complaint about the efforts of UnitedHealthcare to introduce its unpopular laboratory benefit management program in Florida is that the insurer-and its agent, BeaconLBS, a division of Laboratory Corporation of America-don’t respond to physicians when they request guidance. One family practice physician in Jacksonville said that UHC has not even acknowledged several letters he sent via certified mail, return receipt requested.
CEO SUMMARY: From the launch in 2013 of a big accountable care organization in Wisconsin, the North Shore Pathologists at Columbia-St. Mary’s Hospital have been involved. Among the lessons learned are the importance of structuring the pathology contract with the hospital to anticipate value-based reimbursement and having full access to the ACO’s data. The pathologists are using this data to develop test utilization programs that help physicians order the right lab test for the right patient.
CEO SUMMARY: One experienced expert in billing and coding was surprised at the list of 303 tests to be included in the Medicare Laboratory Competitive Bidding Demonstration Project. He notes that the list of 303 tests includes a number of codes and descriptions that are not consistent with CPT codes used by laboratories to prepare
CEO SUMMARY: For pathology groups operating their own histology and cytology labs, a growing problem is access to patients covered by exclusive managed care contracts. In the Northeast, several persistent pathology group practices are using some effective business strategies to fight this trend. Not every strategy works every time, but there are enough victories to
CEO SUMMARY: Regulators believe AmeriPath’s Ft. Lauderdale laboratory submitted claims during 1996 which were based upon improper procedure codes or lacked adequate documentation. AmeriPath “vigorously” disputes the situation. It is still uncertain as to whether this action represents a larger campaign that will target laboratories and pathologists for new issues involving Medicare billing and reimbursement.