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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…
New BlueCard Policies Affect Lab Test Claims
CEO SUMMARY: This new policy from the Blue Cross and Blue Shield Association (BCBSA) becomes effective on October 14, 2012. No longer can a local lab provide service to a member under the BlueCard program and be paid by the local plan in the region where the service was provided….
Blue Cross Execs Discuss Reasons for New Policies
CEO SUMMARY: In recent months, officials from the Blue Cross and Blue Shield Association (BCBSA) have responded to the concerns about new billing protocols for services provided as part of the BlueCard program and voiced by such clinical lab associations as the California Clinical Laborat…
Medicare Extends 5010 Implementation for a Second Time, Effective July 1, 2012
FACED WITH THE FACT that many payers were not ready to implement the 5010 standard under the Health Insurance Portability and Affordability Act (HIPAA), on March 15, the federal Centers for Medicare & Medicaid Services (CMS) announced a second delay in enforcement of the standard…
Form 5010 Changeover Causing Payment Delays
CEO SUMMARY: Even after testing compliance with HIPAA Form 5010 for more than a year, one out of four payers is not ready to pay claims using this new form. Claims payment experts are telling clinical labs to expect some shortfall of revenue in coming weeks as payers struggle to program t…
Medicare Carrier Plans to Reject Molecular Claims
CEO SUMMARY: In September, Palmetto, a Medicare carrier serving California and seven other states, made public two draft local coverage determinations (LCDs) that revamp its coverage guidelines for molecular diagnostic tests (MDT) and laboratory-developed tests (LDT). All labs su…
November 02, 2009 “Intelligence: Late Breaking Lab News”
Digital microfluidics and lab-on-a-chip technologies are being combined to create a new way to measure breast estrogen levels in women. An interdisciplinary group at the University of Toronto developed a lab-on-a-chip technique to analyze blood and breast tissue to identify women at …
March 16, 2009 “Intelligence: Late Breaking Lab News”
In the United Kingdom, there is an interesting development regarding anatomic pathology and clinical laboratory services. The trust which operates the famous 986-bed Guy’s Hospital and 957-bed St. Thomas’ Hospital has entered a joint venture with Serco Gr…
Implementation Date For ICD-10 Is Proposed
CEO SUMMARY: Even though the transition from ICD-9 to ICD-10 will not be required until 2011, laboratories and pathology groups should have a transition plan in place. ICD-10’s 155,000 seven-digit codes will replace the 17,000 five-digit codes of ICD-9. Because of major…
NPI Rules Slow Payments to Pathology Groups, Labs
CEO SUMMARY: New rules requiring use of National Provider Identification (NPI) numbers took effect on May 23. Since then, Medicare carriers and payers nationwide have rejected claims from pathologists and other providers that do not comply with the new NPI rules. A missing NPI on just one…
CURRENT ISSUE
Volume XXXII, No. 6 – April 21, 2025
Now that a federal judge has vacated the FDA’s LDT rule, The Dark Report analyzes the judgement and notes the various steps the FDA could take in response. Also, lab testing at pharmacies is proving to be less successful than was once anticipated.
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