Mark Cuban argues that fines for healthcare overbilling could drive accountability across the system, putting new pressure on insurers, hospitals, and clinical labs to defend pricing and billing practices.
Imagine your clinical lab got fined every time it overbilled. That’s what Mark Cuban is suggesting. Cuban is once again taking aim at what he calls systemic dysfunction in US healthcare—this time framing billing practices by insurers and providers as a source of both patient harm and missed accountability. For laboratory leaders, the comments land amid growing scrutiny of healthcare pricing, reimbursement transparency, and how frontline diagnostics fit into a system under pressure to justify costs.
In a post on X, Cuban argued that routine overbilling, improper claim denials, and misleading patient cost estimates are so widespread that meaningful enforcement could have enormous fiscal impact.
“If we fined insurers and providers $100 every time they over-billed, incorrectly denied care or misrepresented any amount of patient out of pocket, we could pay off the national debt,” Cuban wrote.
“If we fined insurers and providers $100 every time they over-billed, incorrectly denied care or misrepresented any amount of patient out of pocket, we could pay off the national debt,” Cuban wrote. (Photo credit: Wikipedia.)
Cuban Calls for Reform
He went further, describing a healthcare system he believes is intentionally complex and tilted against patients. According to Cuban, insurers and providers benefit from information asymmetry, leaving consumers overwhelmed by surprise bills, opaque pricing, and shifting out-of-pocket costs.
Cuban called for aggressive structural reform, starting with the insurance industry. He argued that major insurers should be broken up and forced to divest non-insurance businesses, followed by similar action targeting hospitals and pharmaceutical wholesalers. The objective, he said, is to restore competition and make healthcare markets more efficient.
The comments were sparked by a post from Tanner Aliff, founder of Scalpel Policy Solutions, who highlighted recent state laws that allow patients to receive “deductible credit” when they pay cash prices lower than typical insurance reimbursements. These policies let patients save money while still having their spending count toward their annual deductible.
Aliff pointed to high-cost imaging as a clear example. Instead of exhausting a deductible on a $6,000 MRI billed through insurance, patients in certain states can pay roughly $300 in cash for the same service and still receive deductible credit—dramatically reducing their out-of-pocket burden.
So far, only four states—Texas, Indiana, Tennessee, and Oregon—have enacted some version of this reform.
Opposition Voices Doubts
Cuban praised the effort and urged broader adoption, arguing that if cash-pay healthcare spending consistently counted toward deductibles, patients could comparison-shop more effectively. He encouraged people in other states to press lawmakers on why similar policies have not been implemented.
Critics pushed back, questioning whether patients can realistically navigate these options, particularly those managing serious or chronic illness. Financial planner Jae Oh argued that expecting consumers to coordinate cash payments and deductible credits is impractical and potentially harmful.
Cuban countered by pointing to his experience through Cost Plus Drugs, saying he regularly helps patients with deductibles and prior authorizations. While he acknowledged that having cash payments credited toward deductibles remains the hardest part, he insisted that the model already works for many patients.
For laboratory leaders, the debate is a reminder that pricing transparency, billing accuracy, and payer behavior are increasingly under the spotlight. As policymakers and high-profile industry voices push for reforms that empower patients, laboratories may face new expectations around cost clarity, reimbursement practices, and their role in a healthcare system being challenged to prove its value and fairness.
Six-month trial program seeks to speed test turnaround times and increase patient safety
Hospitals around the world are increasingly employing drone services to deliver laboratory samples and medical supplies between clinical laboratories. One such six-month test program in the United Kingdom (UK) has drones quickly and efficiently transporting blood samples between Synnovis’ lab at Guy’s Hospital and the lab at St Thomas Hospital through the skies over London.
The medical centers are part of the Guy’s and St Thomas’ NHS Foundation Trust, which has five hospitals, including two of London’s most famous and prestigious teaching hospitals.
NHS partnered with healthcare logistics company Apian and Wing Drone Delivery, a global entity that’s part of Google’s parent company Alphabet, for the six-month drone-delivery trial.
The medical drone service currently delivers blood samples from patients who are at a high risk for complications from bleeding disorders.
Traditionally, delivering blood samples by road between the two locations takes about 30 minutes, depending on traffic. But delivery by drone between the two laboratories takes less than two minutes with the added benefit of decreasing carbon emissions and reducing traffic congestion.
And drone delivery allows for faster analysis of samples, which expedites test turnaround times and helps physicians more quickly determine if patients are safe to undergo surgery.
“This drone trial to deliver blood samples should speed up test results for some of our most vulnerable patients, ensuring they have the very best care,” said Lawrence Tallon, deputy chief executive of Guy’s and St Thomas’, in a news release. “It combines innovations in healthcare with sustainability to give us an NHS fit for the future.”
An NHS drone in flight over London passes by Big Ben. Total flight time is about two minutes, as opposed to 30 minutes by car or courier bike. Click on the photo above to watch a video of the drones in action. (Photo/video copyrights: NHS Guy’s and St Thomas’.)
On-demand Deliveries between Hospital Labs
“Cities like London face a unique challenge. Built vertically but relying on 2D roads, they’re choked by polluting congestion,” commented Alexander Trewby, CEO and co-founder of Apian, in the news release. “Apian’s ambition is to create an autonomous delivery network operating at NHS scale, moving physical items as productively as the internet moves information. If we can pioneer drone delivery here, we can do it anywhere!”
The project is regulated by the UK Civil Aviation Authority (CAA) and initially started in October of last year as a six-month trial, which ended on April 7. The CAA extended the project’s airspace approval for an additional six months. The NHS project now has an expected end date of October 7, 2025.
“Drones can increase the responsiveness and resilience of healthcare logistics, allowing clinicians to be more productive and patients to get the care they need sooner,” Hammad Jeilani, co-founder of Apian, told Healthcare-in-Europe.com. “An NHS drone delivery network in London, starting with this innovative trial, will provide on-demand, automated and sustainable deliveries, helping the NHS create more efficient models of working [with] our doctors and nurses to deliver the highest quality care for patients.”
The drone service runs Monday through Friday during daylight hours and cannot exceed 40 flights per day. During the first six months of operation, there were around 10 flights per day.
Informing Patient Care Quickly
“Tens of thousands of essential patient samples are analyzed by pathology laboratories across London each week,” said Dominic Harrington, PhD, chief scientific officer at Synnovis, in the NHS news release. “Reducing the time it takes to transport these samples means results are available more quickly to inform best possible patient care.”
The Wing drone used for the service is primarily made of foam, weighs about 11 pounds, and can carry packages weighing a little over two pounds. It cruises approximately 62 miles per hour at a height of around 230 feet above the ground.
The use of drones in healthcare is becoming more popular worldwide and the success of such endeavors is evident. In the future, clinical laboratories may depend on drone deliveries to help facilitate optimal results for patients.
Sophie O’Sullivan, director of future of flight at the CAA, told Healthcare-in-Europe.com, “Innovative trials like this from Guy’s and St Thomas’, Apian, and Wing help demonstrate the many positive and safe ways that drones can be used for society—in this case, to improve patient outcomes and deliver significant environmental benefits.”
The Office of Management and Budget (OMB) concluded its review of the final rule on April 22. Former FDA commissioner Scott Gottlieb, MD, and other regulatory experts expect the White House to send the final rule to Congress as early as late April and no later than May 22.
On Tuesday morning, Lâle White, executive chair and CEO of San Diego’s XiFin, Inc., will present a keynote on new regulations and diagnostics players that are “poised to reshape lab testing.” Her presentation is followed by a general session on Clinical Laboratory Improvement Amendments (CLIA) regulations featuring Salerno Reynolds, PhD., acting director at the U.S. Centers for Disease Control and Prevention (CDC) Center for Laboratory Systems and Response.
Robert Michel, Editor-in-Chief of The Dark Report will wrap day one with a general session on the regulatory trifecta coming soon to all labs, from LDT to CLIA to private payers’ policies for genetic claims.
Innovation in the spotlight
“It’s a rich mix of expert speakers, lab leaders who are doing innovative things in their own organizations, along with the consultants and the lab vendors who are pushing the front edge of laboratory management, operations, and clinical service delivery,” says Michel, who each year creates the agenda for EWC.
Several sessions, master classes, and speakers will look to the future with discussions about how healthcare data drives innovations in diagnostics and patient care, digital pathology adoption around the world, and hot topics such as artificial intelligence (AI), big data and precision medicine.
Panels offer a variety of viewpoints
“One valuable benefit of participating at the Executive War College is the various panel discussions,” Michel says. “Each panel brings together national experts in a specific area of the laboratory profession. As an example, our lab legal panel this year brings together four prominent and experienced attorneys who share opinions, insights, and commentary about relevant issues in compliance, regulations, and contractual issues with health plans and others.”
This allows attendees to experience a breadth of opinions from multiple respected experts in this area, he adds.
For example, a digital pathology panel will bring together representatives from labs, service providers, and the consultants that are helping labs implement digital pathology. The session will be especially helpful to labs that are deciding when to acquire digital pathology tools and how to deploy them effectively to improve diagnostic accuracy, Michel says.
And a managed care panel will feature executives from some of the nation’s biggest health plans—the ones that sit on the other side of the table from labs—to provide insights and guidance on how labs can work more effectively with them.
Networking opportunities abound
The event is about much more than politics and policy, however. There’s also a distinct social aspect.
“Everyone is welcome, and everyone appreciates the camaraderie, so don’t be shy about going up and introducing yourself to someone. The quality of the crowd is top-notch, yet I’ve always experienced a willingness for those of us who have been to this rodeo to always be welcoming,” she notes.
Michel agrees. “One of the special benefits of participation at the EWC is the superb networking interactions and collaboration that takes place,” he says.
“From the first moments that attendees walk into our opening reception on Monday night until the close of the optional workshops on Thursday, one can see a rich exchange happening amongst circles of attendees. Introductions are being made. Connections are developing into business opportunities. The sum of an attendee’s experience at the Executive War College is to gain as much knowledge from the networking and collaboration as they do from the sessions.”
Understanding requirements of digital pathology workflow matters as regulatory and reimbursement elements align toward wider adoption beyond 2023. Upcoming Dark Daily webinar May 10 to cover infrastructure requirements
Nearly all pathology residents and fellows, as well as many histologists and other medical students, have been trained using digital images and, therefore, digital pathology tools. This resounds as a major and important development now working in tandem with recent coding decisions and regulatory recommendations that may combine to advance digital pathology to a significant tipping point.
As Dark Daily’s sister publication, The Dark Report, has described in great detail over the past several years, the trend toward digital pathology implementation started in the mid-2000s. Much has been learned through trial and error that may make the practical path forward clearer for those still on the sidelines.
Digital pathology infrastructure and information technology (IT) requirements are better known after years of research at academic centers throughout the United States—but only for those closest to the action. Two examples are University of Southern California (USC) on the West Coast and Memorial Sloan Kettering Cancer Center (MSKCC) on the East Coast.
During a free 60-minute educational webinar on May 10, W. Dean Wallace, MD, (far left) of University of Southern California (USC) and Orly Ardon, PhD, MBA, (immediate left) of Memorial Sloan Kettering Cancer Center (MSKCC) will explain digital pathology infrastructure, IT, and lessons learned through firsthand experiences. The webinar is sponsored by Hamamatsu, and continuing education credit is available for listening.(Photo copyrights: USC and MSKCC.)
Seven Advantages of Early Adoption of Whole Slide Imaging and Digital Pathology
Many pathologists know that academic centers throughout the U.S. have been the first to adopt and use digital pathology scanners and systems. Early work in what have become custom digital pathology ecosystems has enabled academic pathology groups to:
Learn how to implement, validate, and design workflows that include digital pathology systems and computational pathology.
Determine how physical environments need to change for slide scanners, achieving quality images, maximizing scanner utility, and expanding scanning capabilities in medium- and high-throughput laboratories.
Contract with pharmaceutical companies and drug developers to read digital images in support of drug research and clinical trials.
Understand how digital pathology applies for various use cases, including primary diagnosis, frozen section diagnosis, consultations, second opinions, and telepathology.
Successfully spread pathologist technical and professional support across multiple laboratory locations and remote customers.
Learn best practices for conducting tumor boards and peer reviews of pathology cases.
Validate and verify new hematoxylin and eosin (H&E) stains.
Hospital and Lab Leaders Have Questions About Digital Pathology Requirements
As a result of early adopter projects, digital pathology infrastructure and IT requirements are better understood and documented for a variety of use cases, according to W. Dean Wallace, MD, Professor of Pathology at the Keck School of Medicine of USC. Wallace specializes in pulmonary and renal pathology with a strong interest in informatics, as well as radiology and pathology correlation, and he warns of the danger of implementing an “incomplete digital pathology system.”
This webinar is for hospital and health system leaders, as well as independent pathology groups and reference lab executives, who want to know:
Key workflow aspects of the components needed in a digital pathology service.
Common limitations of commercial digital pathology products.
How to structure a digital pathology implementation team.
A goal-based approach to developing a business case for digital pathology implementation.
Wallace and Orly Ardon, PhD, MBA, Director of Digital Pathology Operations at MSKCC, will lead the call and take questions during the webinar’s live Q&A segment.
Questions About Digital Pathology Implementation
At MSKCC, teams have scanned and archived more than six million histology slides and are prospectively scanning all in-house H&E slides.
“There is a lot of interest out there for digital pathology implementation,” Ardon told Dark Daily, “not only the AI-machine learning opportunities that are enabled with digital slides, but how do we even start a basic digital pathology journey. Institutions and labs don’t realize how many factors they have to think about before they start scanning the first slide.”
“People have limited understanding of the complexities of the business case,” Wallace added. “Do you want to go with a full 100% deployment or a targeted deployment? Do you want to get digital pathology to support tumor boards? By introducing scanners into the tumor board workflow, you can actually cause more problems than you are solving if you are not careful.
“The other aspect of it is the actual technical deployments. You need to begin with careful analysis of functions or services to support,” Wallace said, adding the soft costs of digital pathology can take lab and pathology administrators by surprise.
Ardon and Wallace will present their insights and experiences during the webinar, which has been sponsored by Hamamatsu. Those interested can learn more and register at Dark Dailyhere. P.A.C.E. credit is available for this program through the American Society for Clinical Laboratory Science (ASCLS).
On the Horizon: Incentives and Further Alignment Toward Digital Pathology Adoption
Dark Daily’s new webinar is timely. Earlier this year, the Centers for Medicare and Medicaid Services (CMS) entered what has been called a “tryout” period to gather data about the use of new, digital-pathology-related Current Procedural Terminology (CPT) codes in clinical laboratories and anatomic pathology groups. (See coverage in The Dark Report.)
Some believe the efforts of CMS, clinical labs, and pathology groups will result in new reimbursable codes, reimbursement values, and other incentives for using digital pathology (starting sometime in 2024)—if analysis shows use of digital pathology is as widespread as numerous publications would seem to indicate.
The CPT coding development coincides with recent discussions within the federal Clinical Laboratory Improvement Advisory Committee (CLIAC) about sweeping recommendations to allow continued remote work once the COVID-19 Public Health Emergency ends on May 11 and recognize digital data as a vital component of diagnostic specimens. (See coverage in The Dark Report.)
CLIAC’s recommendations may translate into a running start for modernizing the Clinical Laboratory Improvement Amendments of 1988 (CLIA). CLIA as it is written currently is dated and needs to account for new and emerging technologies, such as digital pathology, medical laboratory industry sources have said for years. (See a recent Dark Report – Dark Daily webinar.)
These developments, as they further align with actions by the U.S. Food and Drug Administration (FDA), could unleash swells of interest in onboarding whole slide scanners and digital pathology tools. Remote workflows became a priority during the COVID-19 pandemic, and it appears they will continue for a period as the Public Health Emergency unwinds, according to the FDA.
Watch Digital Pathology Implementation Strategies
Most executives at hospitals and health systems, private pathology practices, and independent reference labs are on the sidelines watching how digital pathology in research and clinical practice is unfolding.
However, as the pathology field integrates data science and computational pathology, forward-looking hospital and lab leaders can expect greater momentum toward advanced technologies, such as digital pathology tools.
Register here to participate in the upcoming webinar, “Digital Pathology Implementation Strategies.”
—Liz Carey
This content was developed through independent research and interviews by The Dark Intelligence Group, with support from Hamamatsu Photonics K.K., a provider of whole slide imaging systems and related technology such as optical sensors, light sources, and complex instrument systems that use them. Hamamatsu did not participate in the article’s development. Learn more about Hamamatsu at https://nanozoomer.hamamatsu.com/us/en.html.
Answers and effective solutions to the lab profession’s most urgent challenges will be front and center at the innovative ‘Lab Management Essentials Workshop’
Three powerful forces are slamming clinical laboratories today. One is the urgent need to cut costs. Second is the struggle to achieve and maintain full lab staffing. Third is the pressure to increase revenue and expand market share.
All of this is happening even as hospitals and health systems must deal with almost identical issues. Cost-cutting, recruiting more staff, and finding ways to increase revenue dominate the thoughts and actions of senior health administrators.
Most Hospitals and Health Systems Report Substantial Financial Losses
News reports about the financial losses at hospitals and health systems tell the story. For example, one report in Becker’s Healthcare described the financial damage at three major, multi-state health systems:
AdventHealth, a 48-hospital health system, reported a $417.7 million net loss in the first quarter of 2022. It reported that, because of inflation, costs had increased by 15% over prior year.
Kaiser Permanente, with 12.6 million members in seven regions of the United States, reported a net loss of $961 million in the first quarter of 2022. One major factor in these losses was the increase in expenses, which was 9.5%. For second quarter 2022, Kaiser Permanente showed a loss of $1.3 billion, most of that from a decline in the value of its investment portfolio.
Ascension Health, with 143 hospitals in 19 states, reported a net loss of $884.7 million in first quarter of 2022. It said its costs increased by 10.6% over the same period last year.
Most hospital-based clinical laboratory managers and pathologist are aware of these staggering financial losses. They also are watching how the shortage of nurses and other skilled personnel has hospitals scrambling to close that gap by paying more overtime, using temporary nurses who are paid at much higher rates, and increasing nurse salaries to prevent existing staff nurses from taking more lucrative offers from other hospitals in the community.
Clinical Laboratories Under Pressure to Cut Costs and Maintain Adequate Staff Levels
Hospital-based laboratories are on the frontline of these hurricane forces. Facing operating losses, hospitals ask their laboratories and other clinical service lines to cut costs below authorized budgets. Meanwhile, the labs themselves must deal with their own shortage of medical technologists (MTs) and clinical laboratory scientists (CLSs)—along with other skilled positions—that are required to provide the full menu of lab testing services.
This “perfect storm” of pressures to cut costs, keep staffing at authorized levels, and generate more revenue (that can offset rising costs of lab supplies and the higher salaries being paid to MTs and CLSs) is without precedent in the past four decades. To provide lab managers with the knowledge to resolve these challenges swiftly and confidently in their own laboratories, the team behind the Executive War College assembled experts to conduct a one-and-a-half-day interactive workshop.
Using Lab Case Studies to Teach Proven Solutions for Reducing Expenses
Each of the three important topics will be addressed in half-day learning modules. Following case study presentations on best practices, attendees at Lab Management Essentials will break out into smaller roundtable groups facilitated by lab industry experts. The groups will brainstorm how to apply these proven methods to cut costs, retain employees, and create revenue. They will then describe their findings to all participants.
Lab Management Essentials Workshop facilitators (clockwise from top left): Tafney Gunderson, Carlton Burgess, Dorothy Martin, Rick VanNess, Jane Hermansen, and Kim Zunker.
On the morning of day one, leaders of the lab cost-cutting module will be:
Carlton Burgess, Vice President of Laboratory Services at Prime Healthcare in Ontario, Calif.
Tafney Gunderson, Quality Systems Supervisor at Avera McKennan Laboratory in Sioux Falls, S.D.
On the afternoon of day one, leaders of the lab staff recruiting, hiring, and retention module will be:
Dorothy Martin, Regional Laboratory Manager at Dartmouth-Hitchcock Health in Lebanon, N.H.
Kim Zunker, MBA, MLS(ASCP), CAPM, Consulting Manager at Accumen in Scottsdale, Ariz.
On the morning of day two, leaders of the lab staff recruiting, hiring, and retention module will be:
Jane Hermansen, MBA, MT(ASCP), Manager of Outreach and Network Development at Mayo Clinic in Rochester, Minn.
Rick VanNess, Director of Product Management at Rhodes Group and TriCore Reference Laboratories in Albuquerque, N.M.
Delivering Essential Knowledge to Up-and-Coming Laboratory Managers
This Lab Management Essentials workshop is a first for the clinical laboratory profession. It brings together experienced, effective lab leaders to teach, guide, and coach your lab’s smartest up-and-coming lab managers. It accomplishes this in just one-and-a-half days, to minimize the time they are away from your lab.
To gain maximum benefits from this well-designed program, it is recommended that you send three or four of your front-line lab managers. Together, they will hear and learn at the same time, while working during the intimate sessions to identify the techniques and methods that will work best for your lab. This is important because, upon their return, they will have both enthusiasm and the knowledge to light the right fires under your lab staff and energize them into quickly deploying ways to slash expenses, attract top candidates to fill open positions, and even to tap new sources of revenue—all of which they learned during Lab Management Essentials.
Because the number of attendees to each workshop is limited, you are encouraged to click here to register yourself and your designated lab managers today.
Some lab experts advise that clinical laboratories and pathology practices should also plan on delayed payments for COVID-19 testing for uninsured patients
Regardless of whether infection rates for SARS-CoV-2 continue to wane or perhaps surge again, business changes are coming for staff at clinical laboratories and anatomic pathology groups. Forward-thinking lab administrators will want to evaluate post-pandemic strategies for labs to stay ahead of potential legal issues and keep their organizations financially healthy.
The public health emergency stemming from COVID-19 is set to expire April 16. That deadline could be extended. However, the U.S. Department of Health and Human Services (HHS) is under pressure from some circles to end the public health emergency, which would affect some health insurance provisions and potentially rein in relaxed rules for telemedicine.
“If you’re a laboratory, now is the time you need to start buttoning up [the above] concerns. You don’t want to be at the mercy of a quick cutoff,” said Jon Harol, president of Lighthouse Lab Services in Charlotte, N.C. The company hosted a webinar last week called “Preparing Your Clinical Lab or Pathology Practice for Post-COVID Success.”
Pathologists and clinical laboratory leaders should consider post-pandemic strategies for labs in the following areas:
COVID-19 testing for uninsured patients;
Preparations for government audits of SARS-CoV-2 tests performed during the pandemic; and,
Repurposing PCR equipment used for COVID-19 testing into other areas of clinical diagnostics.
These strategies will be explored further during the Executive War College Conference on Laboratory and Pathology Management, which takes place April 27-29 in New Orleans. Leaders of innovative clinical laboratories will share how their lab teams are helping to improve patient outcomes while encouraging health insurers to pay them for this value.
COVID-19 Testing for Uninsured Patients
On March 22, the U.S. Health Resources and Services Administration (HRSA) announced that its COVID-19 Uninsured Program stopped accepting claims for testing and treatment due to lack of sufficient funds. This development affects 8.6% of the nation’s population that doesn’t have medical insurance, according to the U.S. Census Bureau.
For clinical laboratories, the announcement could lead to delayed payments for COVID-19 tests performed on uninsured patients, said Mick Raich, President of Revenue Cycle Management Consulting at Lighthouse Lab Services, who also spoke during the webinar. Medical laboratories and pathology groups should anticipate reimbursement gaps and how that might affect revenues collected from payers.
“The patient relationship is going to be the most important thing. That puts labs at the head of the table,” says Jon Harol, president at Lighthouse Lab Services.
“Labs are going to do the testing and are going to bill for it, and there will probably be some retroactive payment,” Raich explained.
With midterm elections happening this year, don’t be surprised to see HRSA funding reinstated for COVID-19 testing for uninsured people, commented Robert Michel, Editor-in-Chief of The Dark Report and Founder of the Executive War College.
“We’ll have to wait and see. After all, it is an election year, so the representatives and senators in Congress would like to be re-elected,” added Michel, who also presented during the webinar.
“It is reasonable to assume that members of Congress don’t want to disappoint the clinical laboratories that stepped up to the table in the earliest days of the pandemic and have done huge volumes of COVID-19 testing.”
Preparations for Government Audits of Pandemic Testing
Another post-pandemic strategy for labs: Prepare for audits of COVID-19 test claims from the HHS Office of Inspector General (OIG).
Ahead of any OIG action, labs should consider performing self-audits to determine whether they complied with HRSA requirements. “The best thing you can do is go back and look at the first two months of your billing. Do an audit to ask: Did we bill anybody with insurance by accident?” Raich suggested. “Take a hundred of those claims and audit them.”
If a medical lab finds problems with uninsured COVID-19 billing, it may be prudent to self-report those discrepancies to the government rather than ignore them. “That looks a lot better to the OIG than tucking the stuff in a desk drawer and waiting for someone to knock on your door,” Raich noted.
Harol predicted the OIG will also review another aspect of how COVID-19 test claims were coded. Auditors will want to see if PCR test claims coded for higher reimbursement if the results were reported within 48 hours actually met that requirement.
“I expect that we’ll see auditing of the coding that was used. Under COVID, you got paid more if you were running tests on a high-throughput platform. It was almost an honor system there. I don’t know that I’ve seen much outside verification of that,” Harol explained. “I’m curious to see if there will be OIG pushback and more documentation required to prove the code was correct.”
Repurposing PCR Equipment Used for COVID-19 Testing
When the pandemic finally winds down, there will be less demand for COVID-19 testing, which could leave PCR equipment collecting dust unless labs make plans now on how to repurpose those systems.
“If you have a PCR instrument that can be revalidated, you want to start thinking about putting in a panel that tests for UTIs, sexually transmitted diseases, respiratory diseases, or women’s health,” Harol explained. “Those types of tests can be done on the equipment that a lot of COVID testing was being performed on, and it can be performed by the same scientists with that same skillset. That’s the low-hanging fruit.”
The next step is more complicated: Moving into the future, clinical laboratories need to determine what menu of tests will meet the needs of patients who previously submitted COVID-19 specimens for testing.
“The patient relationship is going to be the most important thing. That puts labs at the head of the table,” Harol continued. “How can you market your laboratory services directly to patients who might be interested?”
Watch for Developments in Telemedicine
Any post-pandemic strategies for labs will be influenced by how state governments and federal health officials regulate telemedicine in the future.
Pathologists and clinical laboratory directors should keep their eyes on whether telemedicine rules revert to more onerous requirements once the public health emergency lifts. Before the pandemic, rules for physicians licensed in one state generally limited when they could practice over state lines through telemedicine.
“In response to the pandemic, both the federal government and the states relaxed many prohibitions on the practice of medicine across state lines. This is significant for pathologists,” Michel said. “There is speculation that once government officials let this genie out of the bottle regulatory-wise, they won’t be able to put it back in. Thus, there are many predictions that officials at the state and federal level will be under pressure to retain the newer telemedicine rules after the pandemic has ended.”
Telemedicine proved to be a big benefit for Medicare patients during the pandemic. A report from HHS in December indicated telehealth visits in 2020 for Medicare beneficiaries increased 63 times, from approximately 840,000 in 2019 to 52.7 million. That fact should catch the attention of clinical lab managers and pathologists who want to keep their labs at the front edge of clinical services. For Medicare beneficiaries who see their physicians virtually, labs need the capability to access that patient so as to collect the samples needed to perform those tests ordered by the physician during the telehealth consultation.
