Executive War College on Clinical Laboratory and Pathology Management Returns in November with Emphasis on New Clinical and Financial Opportunities

Following a nearly two-year disruption due to the SARS-CoV-2 pandemic, pathologists and clinical laboratory professionals once again have an opportunity to gather and learn from each other It is good news that the daily number of new cases of COVID-19 continue declining here in the United States. That fact, and the growing number of vaccinations, have encouraged state and federal officials to lift many restrictions on business and social activities. Clinical laboratories are watching a big...

What It Means to Be a Clinical Laboratory Whistleblower Outlined in Newly Released ‘Tell-All’ Book by Lab Executive Chris Riedel

Book provides detailed road map for clinical laboratory professionals who believe they have a valid case to file under the federal qui tam statute, as well as lab owners who want to understand what motivates whistleblowers and what practices to avoid Several high-profile whistleblower cases uncovering massive fraud have shocked the clinical laboratory industry over the past decade. Media coverage nearly always focuses on the court battle and subsequent renderings of justice. But little is...

Getting Paid for COVID-19 Test Claims: Ways for Clinical Laboratories to Make it Happen Faster While Avoiding Post-Payment Audits

Legal, regulatory, and payer experts outline steps that help medical laboratories better navigate federal and state regulatory guidelines, eliminate coding and billing missteps, and maximize reimbursements Even as daily COVID-19 test numbers continue to decrease, many clinical laboratories have substantial numbers of COVID-19 test claims that remain unpaid. Despite federal and state law requiring that labs be paid for these tests, commercial health plans are using many strategies to avoid...

OIG Report Indicates Fraudulent Upcoding at Hospitals is More Prevalent than Expected, Recommends More CMS Oversight and Auditing of Medicare Spending

Oddly, as upcoding severity levels have risen, reported higher-severity inpatient hospital stays have dropped, OIG reported Medicare upcoding fraud is a growing problem for the federal Centers for Medicare and Medicaid Services (CMS). Now, a report from the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) suggests that the practice is increasingly occurring for high-severity inpatient hospital stays that account for the most expensive part of US healthcare....

Concert Genetics, XIFIN, Bruce Quinn, MD, PhD, and The Dark Report to Update Clinical Laboratory Professionals on the State of the Genetic Testing Marketplace

Physician use of genetic tests continues to grow at robust rates, even during the pandemic, but uncertainty about managed care reimbursement hangs over the market It may surprise many pathologists and clinical laboratory managers to learn that the market for genetic testing is robust and growing swiftly, even in the midst of the COVID-19 pandemic. At the same time, the explosion in both the number of unique genetic tests available to physicians, and the willingness of doctors to order genetic...

CMS’ Latest Value-Based Care Reimbursement Model Explores Geographic Direct Contracting for Medicare, Focuses on Costs and Quality

Physicians engaged with CMS in value-based care are asking clinical laboratories to help them close gaps in patient care through testing   Clinical laboratories know that any change to how the federal Centers for Medicare and Medicaid Services (CMS) reimburses healthcare providers could also affect how labs are reimbursed for services they provide. Thus, lab leaders will want to take note of the latest value-based reimbursement model being tested by the Center for Medicare and Medicaid...
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