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July 1, 2019 Intelligence: Late Breaking Lab News

Intelligence Late & Latent News

In Houston, news outlets report that MD Anderson Cancer Center was cited for serious deficiencies and the potential for patient harm, following inspections by officials from the federal Centers for Medicare and Medicaid Services (CMS) and the Texas Department of State Health Services. After an adverse patient event involving transfusion services that occurred in December,

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AP Practices Cautioned to Focus on Expenses

Anatomic pathologists often pay close attention to revenue while ignoring their group’s spending

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 conversations about revenue tend to obscure the need to talk about expenses, effective financial

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Labs Should Heed Lessons from Huge Data Breach

PHI of 20 million patients from four of nation’s largest clinical lab companies was compromised

CEO SUMMARY: Following news last month about the biggest breach of personal health information in the clinical lab industry, lawyers representing some of the affected patients filed at least 12 class action lawsuits. Federal officials and attorneys general in multiple states also launched investigations. The breach occurred when hackers gained access to the data systems

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Four Insurers, Quest Developing Blockchain

Synaptic Health Alliance now using blockchain to improve accuracy of provider databases, directories

CEO SUMMARY: Organizations developing blockchain technology say it is a tamper-proof method of sharing data across networks and among providers, health insurers, and health systems. The Synaptic Health Alliance includes four of the largest health insurers, a health network, and Quest Diagnostics. Its first project, now in its second year, will use blockchain to create

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Aetna Ends Payment for Professional Component

Insurer says it will stop out-of-network payments for pathology review of clinical laboratory tests

CEO SUMMARY: As of Aug. 1, Aetna will stop paying out-of-network pathologists for the professional component review of certain clinical pathology tests. Until now, the health insurer has paid for the professional component when out-of-network labs billed for clinical lab tests using the modifier 26. In a notice to labs, Aetna said it will pay

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Anthem Rolling Out More Anatomic Path Price Cuts

Insurer is also moving pathology groups from professional contracts to ancillary service contracts

CEO SUMMARY: Anthem is making big changes to its relationships with anatomic pathology groups. Getting most of the attention at the moment are the insurer’s letters announcing price cuts for anatomic pathology services of 50% to 70% of Medicare fees. But another major change may also trigger negative consequences for pathologists. Anthem is moving pathology

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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 laboratory claims submitted with the modifier 26 for professional component services.

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