Sep 30, 2013 | Laboratory Management and Operations, Laboratory News, Laboratory Sales and Marketing, Managed Care Contracts & Payer Reimbursement
Implementation of the proposed Medicare rules is likely to lead to the financial failure of many smaller medical laboratories, thus disrupting medical care in many communities across the United States
Three newly proposed Medicare regulations announced last month are major threats to the clinical laboratory testing industry. In fact, one medical laboratory industry executive asserts that implementation of the proposed Medicare rules could result to such an extent that only two large testing companies may be left if the proposed Medicare regulations become final.
Proposed in July, these Medicare rules, “would change the practice of pathology in this country and severely affect patient care—especially for patients with cancer,” wrote Marc D. Grodman, M.D., President and Chief Executive Officer of Bio-Reference Laboratories, Inc. (NASDAQ: BRLI), of Elmwood Park, New Jersey. Grodman’s opinions were published in an op-ed article in The Hill newspaper in Washington, D.C.
The Hill is published daily when the U.S. Congress is in session. It is an influential publication and is widely read by elected officials, their staffs, lobbyists, and government officials. (more…)
Sep 4, 2013 | Coding, Billing, and Collections, Digital Pathology, Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations, News From Dark Daily
As medical laboratories struggle to reduce costs and squeeze their budgets, it is essential that the lab’s quality assurance/quality control program is run properly to protect and enhance the analytical integrity of lab test results
When does budget cutting in a clinical laboratory begin to undermine the accuracy and analytical integrity of the medical laboratory test results produced by the laboratory?
This question is apparently a subject of much discussion within some lab organizations where aggressive cost reduction programs are shrinking lab staff and reducing funds spent on controls and similar QA/QC resources.
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Aug 30, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Managed Care Contracts & Payer Reimbursement
Confusion, unhappiness, and many unresolved issues remain about the way government and private payers are handling claims for molecular diagnostic tests covered by the 114 new CPT codes
Dust is settling from the fiasco triggered by the Medicare program’s failure to be ready on January 1, 2013, to settle molecular diagnostic test claims filed under the 114 new Tier 1 and Tier 2 molecular CPT codes. The damage is not just limited to Medicare test claims, but also involves private health plans that were waiting to let the Medicare program set precedents on coverage and prices for the new molecular test codes.
Many Clinical Laboratories Must Cope With an Unsatisfactory Situation
Although federal Medicare officials and Medicare contractors have scrambled to rectify the situation, even today there is much unhappiness across the clinical laboratory industry about the current state of things. That unhappiness extends to state Medicaid and private payers because many of these payers have been slow to publish coverage guidelines and prices for these new molecular test CPT codes.
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Aug 9, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Pathology
Last year, hospital-run ACOs outnumbered physician-led ACOs, but this year, the opposite is true, creating opportunities for pathologists and clinical laboratories
Until recently, the popular wisdom was that hospitals and health systems would tend to play dominant roles in most accountable care organizations (ACOs). However, new data shows that physicians are holding their own in the formation and management of ACOs.
This is an auspicious development for local clinical laboratories and pathology groups. Physician-run ACOs are much more likely to consider using an independent medical laboratory provider. (more…)
Jun 21, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Pathology
Medicare contractors are setting prices that are 40% to 60% lower than they paid medical laboratories last year for these same molecular diagnostic tests
Non-payment for most new molecular diagnostic test CPT codes continues to be a problem for the majority of medical laboratories across the country.
A lack of payment for these claims, have forced some clinical laboratories and pathology groups to stop doing molecular testing and lay off staff. At least one lab company shut its doors, blaming non-payment by its Medicare contractor as the primary reason.
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