Jul 18, 2016 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Managed Care Contracts & Payer Reimbursement, Management & Operations
Analysis shows new rule requires data gathering effort that favors larger medical laboratories and thus threatens community labs that serve smaller towns and rural areas
When The Centers for Medicare and Medicaid Services (CMS) issued their Final Rule for lab test market price reporting under the Protecting Access to Medicare Act of 2014 (PAMA) last month, it put the clinical laboratory industry on a path that will have significant financial consequences for all labs, whether large or small. Some experts believe this will be the most disruptive event to the medical laboratory industry in the past 30 years.
By now, the story is well known among pathologists and clinical laboratory directors. That story comes from CMS, which issued the Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule—AKA the Clinical Laboratory Fee Schedule (CLFS)—that directly affects clinical labs. Under this Final Rule, published in the Federal Register, June 17, 2016, “laboratories and physician offices are required to report private payer rate and volume data if they have more than $12,500 in Medicare revenues from laboratory services on the CLFS and they receive more than 50% of their Medicare revenues from laboratory and physician services during a data collection period. Laboratories will collect private payer data from January 1, 2016 through June 30, 2016 and report it to CMS by March 31, 2017.
“The first data reporting period (that is, the period during which data from the collection period will be submitted to CMS) will be from January 1, 2017, through March 31, 2017. All subsequent data collection and reporting periods for CDLTs [Clinical Diagnostic Laboratory Tests], except for ADLTs [Advanced Diagnostic Laboratory Tests], will follow this same data collection and reporting schedule, every three years. Reporting of private payer rates for ADLTs will occur on the same schedule except it will be on an annual basis,” states the Final Rule. (more…)
Sep 2, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
News reports state that Anthem and Cigna have denied payment for some multigene panel tests, saying that the tests are unproven. Other insurers, such as UnitedHealthcare and Priority Health, pay for such tests but only for certain patients
A conflict is building between patients and health insurers over the reluctance among health plans to pay for new, expensive molecular diagnostic assays and genetic tests that clinical laboratory companies offer.
This conflict has caught the attention of the nation’s media. That is probably because it makes a great story, for example, to interview parents who can assert that their sick child suffered because their health insurance plan would not pay for a genetic test the parents believed would make a difference in their child’s clinical care. Of course, pathologists and medical laboratory professionals know that there are a significant number of expensive genetic tests being offered by various lab companies that lack extensive data to support their clinical efficacy. (more…)
Nov 22, 2013 | Laboratory News
In Its Second Year, Medical Home Program of CareFirst BCBS Produced $98 Million in Savings, along with Significant Quality Improvements
One of the nation’s largest patient-centered medical home (PCMH) programs has reduced costs dramatically and improved care quality for the second consecutive year. It recently reported the achievements produced during its first two years of operation.
This accomplishment is more evidence for pathologists and clinical laboratory executives that a properly implemented medical home program can deliver measurable gains in patient outcomes and corresponding reductions in the overall cost of care. In January 2011, CareFirst BlueCross BlueShield started a PCMH program for primary-care physicians (PCPs). It serves about 1 million members in Maryland, Washington, D.C., and northern Virginia.
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Aug 19, 2013 | Digital Pathology, Instruments & Equipment, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations, News From Dark Daily
Clinical laboratories and pathology groups are deploying customer relationship management tools as a way to deliver more value to physicians and other providers
Healthcare’s accelerating shift away from fee-for-service payment and toward value-based reimbursement presents new challenges to clinical laboratories and pathology groups. These new payment models motivate providers to seek strategic partners who can deliver added value.
To succeed in this paradigm, clinical laboratories must differentiate themselves. This will require effective management of client relationships. Labs will soon need to do much more than simply process medical test orders and send lab results back to referring physicians. In fact, early-adopter lab organizations are accomplishing these goals by using client relationship management (CRM) tools.
To serve these lab organizations, vendors are bringing customized CRM tools to market. Unlike the generic customer relationship management products of past years, these next generation CRM products are tailored to meet the complex needs of healthcare organizations. CRM systems that are customized to the needs of clinical laboratories and pathology groups are now available.
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