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How Labs Can Add Value for Providers, Insurers, Pharma

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

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What Labs Can Expect from PAMA in 2019

By Joseph Burns, from the Volume XXVI No. 7 – May 20, 2019 issue

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

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Labs Get High Denial Rates Under New NCCI Rules

By Joseph Burns, from the Volume XXVI No. 6 – April 29, 2019 issue

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

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Best Ways to Gather, Access, Report PAMA Lab Test Price Data to CMS

By Mary Van Doren, from the Volume XXVI No. 4 – March 18, 2019 issue

This is an excerpt from a 2,900-word article in the March 18, 2019 issue of THE DARK REPORT. The full article is available to members of The Dark Intelligence Group.

CEO SUMMARY: This is the first lab industry intelligence briefing which presents the lessons learned by a hospital system lab when it gathered, analyzed, and reported

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Best Ways to Gather, Access, Report PAMA Price Data to CMS

By Joseph Burns, from the Volume XXVI No. 4 – March 18, 2019 issue

CEO SUMMARY: All clinical labs required to report their private payer lab test price data are now in the midst of collecting that data. One big change in PAMA reporting is that the federal Centers for Medicare and Medicaid Services now defines most hospital and health system labs as “applicable labs”and requires them to report

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Useful Lessons for Labs That Report PAMA Data

By Joseph Burns, from the Volume XXVI No. 2 – February 4, 2019 issue

CEO SUMMARY: Will clinical labs heed the lessons learned from the first PAMA private payer market price reporting cycle that CMS conducted in 2017? One major difference is that the definition of applicable laboratories now includes most hospital labs. This creates the opportunity for a larger number of clinical labs to submit their price data

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CEO Offers Lab Strategies for a Post-PAMA World

By Joseph Burns, from the Volume XXVI No. 1 – January 14, 2019 issue

CEO SUMMARY: With so many market forces working against the economic interests of clinical laboratories, it is essential that all labs develop appropriate strategies designed to sustain the quality of laboratory testing services and the financial integrity of the laboratory organization. In this intelligence briefing, XIFIN, Inc.’s CEO, Lâle White, explains five strategies that are

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Key Lab Trends Described At Executive War College

By Joseph Burns, from the Volume XXV No. 7 – May 7, 2018 issue

CEO SUMMARY: Innovative clinical labs and pathology groups are absorbing this year’s Medicare Part B price cuts while continuing to pursue opportunities to add value. A common theme from many speakers at last week’s Executive War College in New Orleans is that the lab must get mastery of its LIS and informatics specifically to enable

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CMS Publishes Final CLFS Rates, Labs Prepare to Cut Staff or Close

By Joseph Burns, from the Volume XXIV, No. 16 – November 20, 2017 issue

MEDICARE OFFICIALS PUBLISHED the final Part B Clinical Laboratory Fee Schedule for 2018 last Friday. Some changes clinical labs will welcome. The rates remain deeply flawed, however, and will cause many labs to lay off staff and others to close, experts said Saturday.

How CMS set the rates remains problematic, stated Julie Khani, President of the

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XIFIN CEO WHITE ANALYZES MEDICARE 2018 FEE CUTS

By judeb, from the Volume XXIV, No. 14 – October 9, 2017 issue

CEO SUMMARY: If the draft lab rates that CMS published Sept. 22 for the Clinical Laboratory Fee Schedule for 2018 go into effect Jan. 1 as proposed, then clinical labs will see a cut of 28% in what they get paid for the top 20 most common tests, according to a recent analysis. The rates

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