Insurer-Organized HIE in California Struggles to Get Participation from State’s Hospitals, Physicians, and Clinical Pathology Laboratories

California insurers are building a massive health information exchange (HIE), but so far only one healthcare system is interested in participating Healthcare Big Data is big business. But it requires large databases with complete records of many patients, including their medical laboratory test results. That’s why two big California insurers would like to build such a data warehouse, however, hospitals and physicians are wary of feeding their patient data into an insurer-organized HIE. Why?...

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...

Class Action Lawsuit Filed in California Names Quest Diagnostics Incorporated as Defendant and Alleges Violation of Antitrust Laws involving Medical Lab Testing

Quest has not yet commented on the lawsuit, which was filed by three individuals who had clinical laboratory tests performed by the nation’s largest public lab company In California last Thursday, three California residents filed a class action lawsuit charging Quest Diagnostics Incorporated (NYSE: DGX) with acquiring competitor medical labs, paying kickbacks to physicians, and developing exclusionary agreements with health insurers to monopolize the market for clinical laboratory testing in...

Hospitals Generally Charge Self-pay Patients Top Price for Care, but Some Providers Now Offer Deep Discounts for Patients Who Pay with Cash

Clinical laboratories and pathology groups may want to review the prices they charge insured patients versus uninsured patients There is a certain irony in the fact that hospitals and other medical providers typically charge patients without health insurance as much as three times what they charge Medicare or an insured patient. This situation is getting increased media scrutiny, which is one reason why clinical laboratories and pathology groups may want to review their own policies for...

California’s New Health Insurance Exchange May be Unexpectedly Low, but Co-pays for Outpatient Services Are Relatively High

High Co-pays for Lab Tests May Create a Collection Nightmare for Clinical Laboratories As new facts about the prices of premiums and the amount of patient co-pays for California’s health information exchange—called Covered California—are published, the news is not likely to be favorable for clinical laboratories and anatomic pathology groups in the Golden State. Of particular note is that Covered California has published a requirement that patients will be charged a $35 co-pay for medical...