CMS Considers Using Artificial Intelligence to Battle Fraud; Medical Laboratories Must Ensure Billing Practices Comply with New Federal Affiliation Regulations

Physicians and clinical laboratories that do business with other healthcare providers who have been denied enrollment in Medicare or had their enrollment revoked are under increased scrutiny Efforts by the Centers for Medicare and Medicaid Services (CMS) to crack down on fraud could soon be bolstered by artificial intelligence (AI) tools, placing new pressure on medical laboratories and anatomic pathology groups to ensure that their billing practices are fully compliant with current federal...

FREE SPECIAL EDITION WHITE PAPER | Critical Factors for Launching a Clinical Decision Support System in the Hospital Laboratory

This white paper—part 2 of a three-part series— provides practical pearls on how a proven decision support solution and one that is a good fit for your lab can be the foundation of an effective laboratory stewardship program, and can greatly assist in controlling utilization and meeting the challenges of value-based care. As well, the paper also clearly explains the points for “buy versus build” laboratory decision support.

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Florida Hospital Utilizes Machine Learning Artificial Intelligence Platform to Reduce Clinical Variation in Its Healthcare, with Implications for Medical Laboratories

Pathologists and clinical laboratory scientists may find one hospital’s use of a machine-learning platform to help improve utilization of lab tests both an opportunity and a threat Variation in how individual physicians order, interpret, and act upon clinical laboratory test results is regularly shown by studies in peer-reviewed medical journals to be one reason why some patients get great outcomes and other patients get less-than-desirable outcomes. That is why many healthcare providers are...

New Value-Based Payment Model for Oncology Care Could Affect How Pathologists and Medical Laboratories Get Paid for Their Services

Centers for Medicare and Medicaid Innovation is considering adding clinical laboratory services to bundled payments in its proposed Oncology Care First model Anatomic pathologists, surgical pathologists, and medical laboratories could find some of their services shifted to a bundled payment scheme as the Center for Medicare and Medicaid Innovation (CMMI) considers a new value-based alternative payment model (APM) for providers of cancer care. CMMI, an organization within the Centers for...

Machine Learning System Catches Two-Thirds More Prescription Medication Errors than Existing Clinical Decision Support Systems at Two Major Hospitals

Researchers find a savings of more than one million dollars and prevention of hundreds, if not thousands, of adverse drug events could have been had with machine learning system Support for artificial intelligence (AI) and machine learning (ML) in healthcare has been mixed among anatomic pathologists and clinical laboratory leaders. Nevertheless, there’s increasing evidence that diagnostic systems based on AI and ML can be as accurate or more accurate at detecting disease than systems without...

Employers Can Save Money by Adopting Self-funded Healthcare Models, and Clinical Laboratories Have Opportunities to Support These Plans

By negotiating directly with healthcare providers, employers cut health insurers out of the loop, at least for certain specified healthcare conditions and surgeries It’s a new trend in how employers provide healthcare benefits for their employees. In order to save money, a growing number of employers are going to low-cost hospitals, physicians, and other providers to contract directly for their services. This may be the opening that allows some clinical laboratories to approach larger...