Success of Harvard Pilgrim Value-Based Pharma Contracts Might Indicate a Transition Away from Fee-for-Service to Value-Based Care in Other Healthcare Areas

New value-based healthcare payment models could have far-reaching effects on medical laboratories and the testing they provide Hospitals, physicians, and medical laboratories recognize the transition from “volume to value” that’s underway in the American healthcare system. Fee-for-service payments for clinical services (regardless of whether they are needed or effective) will soon cease and providers will be increasingly paid on how much value they deliver to patient care. This will...

CMS Begins the New Year by Instituting Fines for Insurance Payers That Issue Error-Filled Provider Directories

Increased accuracy in listings should benefit in-network medical laboratories and anatomic pathology groups Regional and smaller medical laboratories will welcome a new enforcement initiative by the Centers for Medicare & Medicaid Services (CMS). Health insurers now will face fines as high as $25,000 per beneficiary as a sanction from regulators in many states for errors in provider directories that can result in patients receiving surprise out-of-network bills. As the number of consumers...

California Regulators Find Many Problems with the Provider Directories That Health Insurers Make Available to Consumers

In California, a survey found significant inaccuracies in provider directories posted online—may trigger action by regulators to have insurers address this problem Transparency in healthcare is an important trend. In recent years, much attention has been given to increasing the transparency of the prices charged to patients by hospitals, physicians, and medical laboratories. But now the transparency trend is about to drive change in the provider directories that health insurance plans make...

More Media Reports of Health Insurers’ Reluctance to Reimburse for Genetic Tests, Thus Angering Many Patients and Causing Medical Laboratories to Go Unpaid

Pathologists should take note that an increasing number of patients who want genetic tests are complaining when they learn their insurance plan will not pay for such tests Concerned about the increased cost of genetic tests, health insurers are becoming reluctant to pay for many types of molecular diagnostics and gene tests. When refusing to pay for these tests, however, they face a buzz saw of angry patients—many of whom see a genetic test as their last resort for a diagnosis and selection of...

More Media Reports About How Health Insurers Are Reluctant to Reimburse for Genetic Tests, Thus Angering Many Patients and Causing Medical Laboratories to Go Unpaid

Pathologists should take note that an increasing number of patients who want genetic tests are complaining when they learn their insurance plan will not pay for such tests Concerned about the increased cost of genetic tests, health insurers are becoming reluctant to pay for many types of molecular diagnostics and gene tests. As they do, however, they face a buzzsaw of angry patients—many of whom see a genetic test as their last resort for a diagnosis and selection of a therapy that might just...
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