Aug 10, 2016 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Laboratory Testing
Findings of this HCCI study, may increase pressure for more transparency in clinical laboratory and pathology test prices
Consumers in states with high healthcare costs may spend more than twice as much for common medical procedures as patients in other states. That’s a surprise finding in a milestone report from the Health Care Cost Institute (HCCI). The report also revealed that pathology and clinical laboratory tests are among the services with the widest price fluctuations. Prices also were shown to vary significantly within individual states.
The HCCI study is the latest salvo in the battle to provide consumers with healthcare price transparency and likely will increase demands on clinical laboratories and pathology groups to make lab test prices easy to find and understand.
HCCI Report Identifies Wide Variance in Prices of Clinical Laboratory Tests (more…)
Jul 15, 2016 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Management & Operations
Most insurers still determine coverage on a case-by-case basis, but two major payers now have coverage policies that are helpful to clinical labs that perform WES
Whole exome sequencing (WES) is not new for clinical pathologists, but it is becoming more common in a clinical setting as more physicians learn about its uses.
This is due to two reasons. First, researchers are identifying new ways to use whole exome sequencing to improve patient care. Second, the cost of whole genome sequencing continues to fall at a steady rate, making it ever more affordable to use in clinical settings.
As recently as 2009, WES was prohibitively expensive and there was little possibility that insurers would cover the cost of the test, as it was considered experimental. Now, however, evidence is mounting that it is an effective diagnostic tool. Therefore, more payers are announcing coverage for WES for an expanding number of diagnostic purposes. (more…)
Feb 3, 2016 | Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Management & Operations
As tests explore genetic markers related to excessive weight gain, and breast and ovarian cancer, companies as well as employees are seeing returns on investment and participation
In a development that is auspicious for medical laboratories, more genetic tests are making their way into more corporate health benefit plans. Big brands—from Aetna to Visa—are partnering with personalized health companies and clinical lab companies doing genetic testing as they support tests to help employees head-off health risks.
Employers’ sponsorship of genetic testing is a trend that could become more common, noted Fortune. But human resources and benefits experts say the offerings are still uncommon. There are also unresolved issues, such as when genetic test results are inconclusive or questionable.
For medical laboratories, the companies’ genetic testing benefits could prompt more test orders from healthcare consumers. Based on the results of their genetic tests, people might decide to make lifestyle changes, work toward prevention of chronic conditions, and take further tests to assess progress. (more…)
Dec 21, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Health plans increasingly refuse to pay out-of-network providers who they claim often inflate their charges, leaving patients with unexpected medical bills
As health insurers narrow their provider networks in an effort to lower costs and hold down premiums, clinical laboratories and anatomic pathology groups may increasingly be designated as out-of-network providers and find themselves struggling to get paid.
This is particularly true in cases where a hospital is in-network and its hospital-based physicians—including its pathologists—are out-of-network for that same insurer. Following their discharge from the hospital and their insurer’s payment of the hospital bills, patients are surprised to get bills from the hospital-based physicians.
It is a problem that won’t go away soon. That’s because it is increasingly common for patients who are being treated in an in-network hospital to unknowingly receive care from out-of-network doctors, such as pathologists, anesthesiologists, emergency physicians, hospitalists and radiologists, who may not participate in the same plan networks as the hospital does. (more…)
Oct 26, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory Pathology, Laboratory Testing
Recent federal Justice Department memorandum issues guidance designed to seek accountability from individuals and combat corporate misconduct
Pathologists and clinical laboratory managers who want a tougher crackdown on labs and physicians that violate anti-kickback laws welcome the news that in the past year federal courts have sentenced 13 physicians to jail terms of 12 to 63 months for accepting bribes from a discredited medical laboratory company as part of a scheme to defraud the federal Medicare program.
These criminal convictions were part of the federal case prosecuted against Biodiagnostic Laboratory Services (BLS), in Parsippany, N.J..
In addition to those 13 jail sentences, one doctor got 10 months of home confinement, two doctors got 12 months probation, and sentencing for six other physicians is pending. Prosecutors expect more defendants will be sentenced in the coming months. (more…)
