Tough Times Ahead for Anatomic Pathology as Group Revenue Declines and Pathologists’ Incomes Drop Due to Payer Price Cuts, Narrow Networks, and Claims Denials

Many pathology groups report shrinking revenue, yet some innovative pathology groups continue to grow through savvy pricing and by adding value to payers and physicians Times are tough for anatomic pathologists in private practice. Medicare programs and private payers regularly slash prices for both technical component and professional component services. In addition, the growing number of narrow networks means that pathology groups find themselves excluded from access to an ever-larger...

Payers Hit Medical Laboratories with More and Tougher Audits: Why Even Highly-Compliant Clinical Labs and Pathology Groups Are at Risk of Unexpected Recoupment Demands

A related issue is the growing use of contract sales representatives to sell clinical laboratory and pathology testing services and whether such arrangements violate federal compliance requirements More and tougher payer audits are hitting an expanding number of clinical laboratories and anatomic pathology groups in recent months. Across the nation, experts in medical laboratory billing and collections are reporting that health insurers are auditing for a host of issues, several of them...

FDA Pushes Forward with Plans to Regulate Laboratory-Developed Tests, in a Move that Will Impact Many Clinical Laboratory Companies and Pathology Groups

It was national news when the FDA sent notice to Congress on July 31 that it planned to issue draft guidance on regulation of LDTs After sitting in a state of suspended animation for several years, the Food & Drug Administration’s (FDA) plans to regulate laboratory-developed tests are now front and center. On July 31, the FDA served the required 60-day legal notice to Congress that it was ready to move forward to issue rules for regulation of LDTs. If the federal agency wanted to get the...

Pathology Groups and Clinical Laboratories Should Prepare for Medicare RAC Auditors

2011 is the year that Medicare expands its Recovery Audit Program to include providers such as medical laboratories and pathology groups During the next 12 months, many pathology groups and clinical laboratories will undergo their first audit as part of Medicare’s recently-expanded RAC (Recovery Audit Contractor) program. This is a big-dollar audit program. When Congress passed the enabling legislation, it was estimated that RAC would generate $10 billion in recoveries from hospitals,...

CLIA Inspections of Clinical Pathology Laboratories Appear to Be Tougher on Loosely-Managed Labs

Pathologists and medical laboratory managers should be alert to compliance changes CLIA inspections of medical laboratories may be getting more rigorous in certain areas of laboratory operations, according to anecdotal information emerging from the field. Clinical laboratory management consulting firms report that they are experiencing an increased number requests for help from hospitals following a recent CLIA inspection of their laboratories. Laboratory management consultants tell Dark Daily...
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