Unexpected and surprising things continue to happen in the clinical laboratory industry. You might consider that to be one unifying theme to the intelligence briefings we present in this issue of The Dark Report.
For example, a pathology lab company in New Jersey sued UnitedHealthcare (UHC) seeking payment for 46,400 molecular COVID- 19 test claims that are unpaid, representing about $20 million in reimbursement. The odd fact in this case is that the lab company alleges in the lawsuit that UHC is paying a substantial number of COVID-19 test claims for patients covered by an employer’s self-insured health plan, but is withholding payment for claims of patients enrolled in UHC’s fully-insured plans where the insurer is on the hook for the test payment. Might this be true of how this insurer is handling the COVID-19 test claims submitted by other labs? Might your lab be experiencing a similar dichotomy in how UHC pays your COVID-19 test claims? Now you have a reason to review those claims to see if the same pattern exists. (See the story here.)
Starting here, we interview the Chief Information and Technology Officer at Labcorp about his company’s use of artificial intelligence (AI) and machine learning across a wide swath of the lab’s workflow and service lines. This information will help other clinical lab managers better understand why some AI solutions are ready for prime time and can contribute to better performance in the operations of their laboratories.
Once again, The Dark Report is first to identify and describe a new trend in the clinical laboratory profession. The trend is “benefits investigation.” Our intelligence briefing here explains how many patients, especially those on high-deductible health plans (HDHPs), are delaying genetic test orders to give them time to contact different genetic test labs and shop for genetic tests that offer prices they can afford and features they consider best for their healthcare needs.
In addition, actions by the federal government are included in this issue. Last fall, the federal Centers for Medicare and Medicaid Services (CMS) ordered Gamma Healthcare of Poplar Bluff, Mo., to cease testing services because of serious CLIA deficiencies. With that one decision, a lab serving 2,200 nursing homes in 11 states went out of business.