Pathology Laboratory Testing at the Crossroads: Will Payers Deeply Discount Prices for Genetic Tests, or Will Value-Based Pricing Prevail?

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...

Palmetto GBA Execs Explain MolDx, Its New “Molecular Diagnostic Services” Program for Clinical Pathology Laboratories

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...

Palmetto, Medicare’s Biggest Carrier, Proposes to End Code Stacking for Molecular Clinical Laboratory Tests

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...

Threat to Clinical Pathology Laboratories is Payer Pre-Authorization of Genetic Tests

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...
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