Jul 1, 2016 | Coding, Billing, and Collections, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations
This phenomenon is a response to the tens of millions of patients who now have high deductibles that must be met before their insurance kicks in
There’s a new wrinkle on bundled pricing for medical laboratory tests and other healthcare services. Some providers and payers are creating bundled pricing options specifically for the tens of millions of patients now covered by high-deductible health plans (HDHPs).
Patients covered by HDHPs are responsible to pay thousands of dollars out of pocket before their health insurance kicks in. Thus, it should not surprise clinical laboratory professionals that providers and health insurers are collaborating to created bundled pricing (AKA packaged pricing) options that cater to self-pay patients.
Bundling is a method in which healthcare services are grouped together for one pre-determined price. It is intended to decrease costs while providing patients with increased access to high-quality care. Clinical labs and pathology groups will need to negotiate with the organizers of these bundled medical services in order to get adequate payment for their testing services.
Bundled service options are gaining in popularity because more Americans are paying out-of-pocket for medical care. Some people have no health insurance coverage at all. Meanwhile, tens of millions of Americans are enrolled in high-deductible health plans. These patients are typically responsible for paying thousands of dollars in out-of-pocket expenses before their health insurance begins paying for medical services. With so many people seeking more economical choices for their healthcare needs, providers, hospitals, and health insurers are exploring the options bundled pricing offers. (more…)
May 13, 2016 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations
Faster than expected transition from fee-for-service healthcare should grab attention of clinical laboratories and anatomic pathology groups who face financial unknowns under new payment systems
Clinical laboratory executives should take note of a key financial fact. The transition from fee-for-service healthcare to value-based reimbursement is occurring at a faster clip than the Department of Health and Human Services (HHS) anticipated last year when federal officials announced a plan to tie 30% of traditional Medicare spending to alternative payments models by the end of 2016.
That means the transition away from fee-for-service payment for medical laboratory tests and other healthcare services is moving ahead of schedule. As evidence, HHS recently announced it reached the 30% target at the start of 2016, nearly a year ahead of the schedule laid out when the Obama Administration outlined a plan to reward healthcare providers based on quality of care rather than the volume of services they provide.
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Sep 28, 2015 | Coding, Billing, and Collections, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory Pathology, Laboratory Testing
As national health insurers push more risk to hospital systems and medical groups, many hospital administrators become more interested in establishing their own health insurance companies
New modes of provider reimbursement—such as bundled payments and budgeted payments—are motivating hospitals and health systems to reconsider their existing relationships with health insurers. Hospital administrators want to control the dollars they save by improving patient care, instead of allowing insurance companies to capture that money.
To accomplish these goals, more and more hospitals and health systems across the country are making one of three moves:
• Funding their own health plans;
• Partnering with health insurance companies; or,
• Buying health insurance companies.
As this trend gathers momentum, it will put the medical laboratories of hospitals in a much better position to regain access to patients. It can be expected that hospital administrators will include their own clinical laboratories and anatomic pathology providers in their own health insurance provider networks. (more…)
Jul 27, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, News From Dark Daily, Uncategorized
Payment reform unlikely to require legislation or raft of new regulations, but shift to value-based payment model will cost clinical labs and pathology groups
Today there is wide recognition in healthcare that the days of fee-for-service (FFS) medicine are numbered. But what is less certain is how fast government and private payers will introduce other reimbursement models, such as bundled payments and budgeted payments. Clinical laboratories and anatomic pathology groups likely will be the most impacted by this payment shift since their economics are driven by high volumes and FFS payment. (more…)
Feb 1, 2012 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology
Early evidence is that the AQC arrangement encourages providers to more carefully utilize ancillary services, including clinical laboratory and pathology testing
Much attention is being given to the new healthcare payment models being introduced by the Medicare program during 2012. However, quietly—and with much less publicity—private health plans are deploying innovative, value-based payment models.
These developments need to be watched by clinical laboratory managers and pathologists, since it is predicted that the cost of medical laboratory testing will be bundled into most of the value-based reimbursement arrangements soon to enter the healthcare marketplace.
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