Alert! ICD-10 Conversion Is Now 56 Days Away and Could Put Financial Squeeze on Clinical Laboratories and Pathology Groups

Big question for medical laboratory managers is whether Medicare, private health insurers, and medical claims clearinghouses can make a smooth changeover when processing lab test claims using ICD-10 codes Conversion to ICD-10 is now only 56 days away! Physicians are not the only ones with a large stake in the conversion from ICD-9 to ICD-10 that takes place October 1, 2015. Clinical laboratories and anatomic pathology groups will be watching to see whether physicians include appropriate ICD-10...

Medicare Officials Raise Issue of Fraud as Greater Use of Electronic Health Records Increases the Number of Claims Upcoded to More Complex CPT Codes

Issue does not directly affect clinical laboratories and pathology groups, but puts spotlight on some hospitals and physicians who frequently use these codes. Could increased use of electronic health records (EHR) systems be causing more hospitals and physicians to commit fraud because of upcoding? That’s the assertion of certain federal health officials. They attribute the increased proportion of Medicare claims for more complex and more expensive services by some providers to be, in some...

Experts Predict Shortage of Clinical Laboratory Labor Will Create Need for More Sophisticated Laboratory Information Systems

Recent reports show why labs need more robust laboratory information systems (LIS), including a shrinking workforce, new requirements to connect to EMRs in hospitals and physicians’ offices, and the development of health information exchanges. Clinical laboratories nationwide are realizing they need new and more powerful laboratory information systems (LIS) as they seek to process larger volumes of medical laboratory tests with a shrinking number of medical technologists and clinical...

Hospital Laboratories Take Note: Medicaid will Cease Reimbursing for Hospital-Acquired Conditions in 2012

Medicaid policy takes effect on July 1, 2012, and mirrors existing Medicare policy Medicare was the first government program to announce that it would not reimburse hospitals for certain hospital-acquired conditions. Pathologists will be interested to learn that the Medicaid program is now prepared to institute a similar non-reimbursement policy. This fulfills a Dark Daily prediction that other government and private health programs would copy this Medicare policy. As of July 1, 2012, Medicaid...

Clinical Laboratories Beware: Many Payers May Not Be Ready for HIPAA 5010 on January 1, 2012

Bigger challenge will be adoption of ICD-10 across entire U.S. healthcare system in 2013 Two disruptive events in the world of coding, billing, and claims reimbursement are about to engage the full attention of clinical laboratories and pathology groups. First is implementation of HIPAA 5010 forms for claims submission by all types of healthcare providers. This is scheduled to occur on January 1, 2012—just seven months away! Second is implementation of ICD-10 codes. Federal law currently...