News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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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 with high-deductible health plans has grown, the demand for more price transparency by physicians, hospitals, and other healthcare providers has increased, with states such as New Hampshire and Colorado legislating public price transparency websites.

Now the federal government is taking another step toward increased transparency in healthcare by fining payers whose provider directories are not current and include inaccurate listings that may cause consumers to unknowingly select out-of-network providers. This is especially important as insurance providers continue to narrow their provider networks. Increased accuracy in provider directories should help clinical laboratories and pathology groups that participate in insurance networks. (more…)

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