Nov 4, 2013 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Management & Operations
With payouts riding on patient outcomes and value, ACO providers will welcome innovative services that clinical labs and pathologist could provide that improve patient outcomes
Both private health insurance companies and employers are betting on value-based insurance as the key to improving healthy behavior in patients. This will require more patient engagement in managing their chronic conditions. It will also include motivating patients to consider less expensive treatment options, particularly when the more expensive treatment path has limited benefits.
In this way, accountable care brings the patient into picture. It is a trend that opens the door for innovative clinical laboratories and anatomic pathology group practices to develop medical laboratory testing services that payers and employers recognize as contributing to improved patient outcomes—and for which they will adequately reimburse the laboratories providing these services.
Private Health Insurers Have More Flexibility in Design of Health Plans (more…)
Sep 16, 2013 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Management & Operations, News From Dark Daily
Clinical laboratories and pathology groups serving Cigna beneficiaries can expect to see new requirements for genetic tests used to diagnose breast cancer, colon cancer and long QT syndrome
Effective this week, Cigna (NYSE: CI) in Bloomfield, Connecticut, is implementing a new program that requires genetic counseling and pre-authorization for certain genetic tests. This is an important development and clinical laboratory executives can expect to see other health insurers take similar steps.
Cigna wants to control costs and improve the appropriateness of ordering expensive genetic tests. It will start with tests for three conditions and may require counseling for other types of genetic tests if this program is successful. Industry observers expect other health insurers will follow Cigna’s example and also require genetic counseling for a compelling reason: all insurers recognize that more than 50% of all genetic tests may be ordered inappropriately, experts say.
(more…)
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…)
Jul 10, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Managed Care Contracts & Payer Reimbursement, Management & Operations, News From Dark Daily
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 laboratory testing. Some lab industry executives have pointed out that it will be a challenge to collect these co-pays. They expect labs will incur higher costs attempting to collect these co-pays while at the same time seeing a substantial increase in levels of bad debt. However, all of this will not happen until 2014, when Covered California begins providing health insurance coverage.
For one category of insured beneficiaries, there is a bit of good news. Insurance exchange premiums for individuals not covered by employer health plans will be lower than previously expected. Covered California will charge, on average, $321 per month on average for the “Silver,” medium-tier plan, noted Peter V. Lee, Executive Director of Covered California, in a report published by the Wall Street Journal. (more…)
Jun 24, 2013 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Pathology
Health insurers may be poised to leave hospitals and physicians out of their networks, thus potentially cutting out pathologists and clinical laboratories
Clinical laboratory companies that find themselves excluded from health insurers’ provider networks do not need to feel like they were singled out. That’s because health insurers are narrowing their networks by also excluding hospitals and physicians.
Years ago, the “narrow network” strategy was used by HMOs and health insurers to extract rock bottom prices from hospitals, physicians, and medical laboratories. Now this strategy is returning as health insurers develop what they call narrow networks. (more…)
