Sep 11, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing
Medical laboratories and anatomic pathology groups could face payment delays if physicians fail to code lab test claims properly using ICD-10 codes
Just weeks remain before the implementation to ICD-10 begins. This will be a delicate time for clinical laboratories and anatomic pathology groups, since labs must rely on physicians to provide accurate ICD codes that labs must submit on test claims in order to be reimbursed by payers.
The much-delayed shift from ICD-9 to ICD-10 diagnosis codes will take place on Thursday, Oct. 1. When clocks strike midnight, years of debate over whether the conversion will create a financial hardship on physicians—and in turn disrupt payments to clinical laboratories and anatomic pathology groups—will begin to be answered.
The Medicare program requires appropriate ICD codes on medical laboratory test claims for Medicare patients. That is one reason why clinical laboratories and anatomic pathology are financially vested in a smooth conversion process. All Medicare Part B claims for medical laboratory tests must be submitted with an appropriate International Classification of Diseases (ICD) code provided by the physician who ordered the lab tests. The Medicare program will not reimburse lab test claims without an appropriate ICD code. (more…)
Aug 12, 2015 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing
Among all medical specialties, pathologists have a high rate of participation in both Medicare reporting programs
Many pathologists are aware of Medicare’s Physician Quality Reporting System (PQRS) and Electronic-Prescribing Incentive (e-prescribing) Program. But what is less known is that up to 40% of eligible doctors nationwide are opting to not participate and thus get paid less money from the Medicare program.
That high rate of non-participation is not true for one group of practitioners, however. Pathologists had the highest participation rate (78.7%) among specialties in PQRS and recorded the fourth-highest participation rate (80.3%) in the e-prescribing program! Pathologists received an average incentive of $246 for the 2013 e-prescribing program and $384 for the 2013 PQRS program. (more…)
Jun 22, 2015 | Coding, Billing, and Collections, Digital Pathology, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Managed Care Contracts & Payer Reimbursement, Management & Operations
Innovative medical laboratories shared their successes in improving lab test utilization that included physician engagement and close monitoring of key metrics
DATELINE: ORLANDO, FLORIDA—One big challenge facing medical laboratories and anatomic pathology groups in the United States today is the need to transition from a transaction-based business model (increasing specimen volume leads to increasing revenue) to a value-based business model (helping providers improve their use of clinical laboratory tests in ways that measurably improve patient outcomes while controlling or reducing the cost of care.)
Two trends reinforce the need for clinical laboratories to craft strategies to develop new ways to add value to lab testing services.
One trend is the move by Medicare and private health insurers to shift reimbursement for providers away from fee-for-service and toward bundled reimbursement and budgeted reimbursement.
The second trend is the emergence of integrated clinical care organizations. The most visible of these are accountable care organizations (ACO) and patient-centered medical homes (PCMH). What these care delivery organizations have in common is that they require hospitals, physicians, clinical laboratories, imaging centers, nursing homes and other types of providers to work together more effectively so that patients receive healthcare in a seamless fashion because there is a continuum: primary care to specialty care to acute care and back again. (more…)
Jun 17, 2015 | Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Management & Operations
Pathologists’ incomes, which declined in 2013, are back up in 2014 and pathologists’ overall job satisfaction remains strong
When it comes to physician income, pathologists rank just below the median out of 25 medical specialties, according to the “2015 Medscape Physician Compensation Report.” The Medscape study for 2015 put pathologist compensation at $267,000.
This represented a 12% increase over the average pathologist compensation of $239,000 that was reported in the “2014 Medscape Physician Compensation Report.”
According to Medscape’s 2015 report, orthopedists are the highest earners, averaging $421,000 a year. At the other end of the scale are pediatricians who earn less than all other specialties with an average annual compensation of $189,000.
All but two physician specialties saw an increase in their earnings this year. The exceptions were rheumatologists and urologists. (more…)
Jun 5, 2015 | Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations
Clinical laboratories and anatomic pathology groups should develop business strategies designed to support better patient outcomes and reduced costs for ACO patients
Accountable Care Organizations (ACO) are not only growing in number but some ACOs are also reporting outcomes that indicate their value-based reimbursement model may produce better results for patients than traditional fee-for-service (FFS) medicine.
For the pathology profession, this news further emphasizes the need for medical laboratories and group pathology practices to have a seat at the table during the organization of ACOs so they can make a clinical contribution and negotiate adequate reimbursement from the fixed fees paid to ACOs. At the moment, one big question for labs is how they are to be paid under a value-based reimbursement model. (more…)
