Dec 15, 2011 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory Operations, Laboratory Pathology
Big changes in how these lab test claims are handled are just 11 weeks away, and most clinical laboratories are not up to speed on this issue
Note: Dark Daily offers this opinion and commentary by Editor Robert L. Michel
Big changes are coming in how payers handle code stacked claims for genetic tests and molecular diagnostic assays! However, few pathologists and clinical laboratory administrators understand why the collective efforts of payers to control utilization and reimbursement of these types of lab tests have the potential to undermine the financial stability of their medical laboratories and anatomic pathology groups.
The year 2012 is about to arrive and, when it does, it will bring the clinical laboratory testing industry to an important crossroads. Payers—both government and private—are ready to take decisive action to rein in an area of genetic and molecular testing that they consider to be on verge of spiraling out of their control.
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Nov 15, 2011 | Laboratory News, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
Registry for genetic tests and molecular diagnostic assays is one step in process to assess the science and clinical utility
Clinical laboratory and pathologists have dozens of questions about the proposed draft local coverage determinations (LCDs) that Medicare carrier Palmetto GBA issued on September 28. The draft LCDs represent Palmetto GBA’s efforts to identify the growing number of laboratory-developed molecular diagnostic assays and genetic tests.
In an exclusive interview with Dark Daily, Palmetto Medical Director Elaine Jeter, M.D., and Palmetto Vice President Mike Barlow explained the need for the new LCDs and offered insight into the process Palmetto GBA is developing to create a molecular test registry and a coverage determination and reimbursement process. This is an important development for the clinical laboratory industry. (more…)
Nov 11, 2011 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Instruments & Laboratory Equipment, Laboratory News, Laboratory Pathology
Palmetto wants to implement two proposed local coverage determinations (LCDs) on February 27, 2012
Medicare’s biggest local carrier is ready to tackle the problems created when clinical pathology laboratories use code stacks to submit claims for genetic tests and molecular diagnostics assays. Medical laboratories in eight states served by this Medicare carrier are worried about its two draft proposals that could cut off reimbursement for large numbers of molecular diagnostic tests (MDTs) and laboratory-developed tests (LDTs), starting February 27, 2012.
The Medicare carrier is Palmetto GBA, of Columbia, South Carolina. On September 23, it shook up the clinical laboratory industry and pathology profession nationwide when it announced, in a “draft proposal” for a local coverage determination (LCD), that it would not allow labs to submit claims for most MDTs. As noted above, the proposed effective date is February 27, 2012.
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Apr 8, 2011 | Laboratory News, Laboratory Pathology
Health insurers want to control the rapid growth in expensive genetic and molecular assays
For many clinical laboratories and pathology groups, genetic tests and molecular diagnostic assays are the fastest-growing part of the test menu. This is true both in the increased volume of specimens for genetic tests and the growing number of such medical laboratory tests that are accepted for clinical use.
This is a bright spot for the nation’s clinical pathology laboratories. That’s because many genetic tests and molecular assays deliver significant clinical value to the physician and his or her patient—while generating ample reimbursement for the medical laboratory that performs these tests.
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