COVID-19 or Not, Lab Market Enters ‘Twilight Zone’

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Our healthcare system is in a most remarkable state. Even as all providers—including clinical laboratories and anatomic pathology groups—continue to devote considerable resources to meeting the urgent need for SARS-CoV-2 testing, health insurers and regulators continue to issue new requirements governing all aspects of “normal” lab testing activities. 

Today, all clinical labs and pathology groups operate in a strange duality. On one hand, their daily energies are consumed with delivering quality COVID-19 testing services, while dealing with restrictions on how consumers and patients can access hospital and physician services. 

On the other hand, most hospitals, office-based physicians, ambulatory surgery centers, nursing homes, and other providers are offering the usual range of services to patients as they get sick or need acute care. All labs in the United States are supporting these care sites with the routine, reference, and esoteric tests that cover the entire span of diseases and health conditions. 

In the midst of this weird duality, payers and lab regulators throw unwelcome curve balls at the medical laboratory profession. These curve balls range from downward changes in what labs are paid for testing, to more restrictions on how labs submit test claims. And even a state government now provides COVID-19 tests in competition with hospital labs and independent clinical labs! cThis issue of The Dark Report provides examples of each of these changes. We cover Medicare’s new requirements and payment rates for COVID-19 tests reported in less than 48 hours and more than 48 hours. The latest development with UnitedHealthcare’s requirement that labs must register every test and panel they perform with the payer’s new Laboratory Test Registry Protocol if their claims are to be paid after Apr. 1, 2021, is presented here. And read how California has built its own COVID-19 testing laboratory and is now diverting lab instruments, supplies, and test kits away from hospital labs and independent labs in the state.

These are reasons why many lab managers and pathologists might feel like they are characters in the old television show, the “Twilight Zone.” At the very moment they must urgently deal with a pandemic that is unprecedented in modern medicine, all the usual players (payers and regulators) continue to restrict the ability of labs to bill and be paid for their lab testing services.

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