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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Coding Consultant Uses Crowdsourcing for Clinical Pathology Laboratories to Post Amounts Paid by Medicare Contractors for Molecular Test Claims

Medical laboratories have yet to learn how much to expect in payment for molecular pathology test claims submitted to the Medicare program

Concern is rising among pathologists and clinical laboratory directors about what the Medicare program will pay this year for the 104 new molecular test CPT codes. These new CPT codes became effective on January 1, 2013.

Few–if any–medical laboratories have received payments for Medicare claims submitted early in January. That’s because contractors for the federal Centers for Medicare & Medicaid Services (CMS) are just beginning to process those invoices. The first payments for these molecular test claims are expected within the next several weeks.

Help for Clinical Laboratories and Pathology Groups

To help clinical labs and pathology groups address this problem, CodeMap, LLC, a billing and coding consulting company in Schaumburg, IL, is encouraging clinical labs to post the payment amounts for the molecular test claims they get from the nation’s Medicare Administrative Contractors on the CodeMap website at CodeMap then will make this information available to participating medical laboratories and the public.

crowdsourcing graphic

To fill the knowledge vacuum that exists as different Medicare Administrative Contractors use the gap-fill method to develop reimbursement for the 104 new molecular test CPT codes, CodeMap, LLC, of Schaumburg, IL, is using the crowdsourcing solution. Also known as distributed problem solving, CodeMap is inviting clinical laboratories and pathology groups to voluntarily provide data about their payments for Medicare claims involving the new molecular test codes. (Graphic by


Two Surveys Raise Questions about Willingness of Consumers to Pay Pathology Laboratories for Expensive Genetic Cancer Tests

This finding is reinforced by the fact that high-deductible health plans are now the second most popular plan option offered by the nation’s employers

Getting paid for expensive genetic cancer tests is likely to be tougher for clinical laboratories when the patient is covered by a high-deductible health plan. There are two trends that are contributing to this situation, each highlighted by recently-published studies.

One trend is the rapid growth of consumer-driven health plans (CDHPs). The second trend is growing evidence that patients, if they need to pay much money out of pocket, will decline to undergo genetic testing that is suggested by their physicians. (more…)

Three Trends in High-Throughput Gene Sequencing for Pathologists and Clinical Laboratory Managers

Two experts predict that tomorrow’s gene sequencing systems may render large swaths of today’s clinical laboratory obsolete

Gene sequencing is the hot technology in both the biotech and clinical laboratory testing industries. That is because the cost of rapid gene sequencing systems is falling rapidly, even as the speed and accuracy of these latest-generation gene sequencers improves significantly.

It is important that medical laboratories managers and pathologists understand the consequences of this technology development curve. The constantly-improving capabilities of these systems means that rapid gene sequencing and whole human genome sequencing will soon take their place in clinical laboratories and anatomic pathology groups.

Pathology Testing for Molecular Genetics “Not Ready for Prime Time”

Experts at National Comprehensive Cancer Network conference voice opinions

It may surprise many pathologists and clinical laboratory managers to learn that a number of prominent healthcare leaders recently voiced significant reservations about the current status of molecular genetics testing. In their view, clinical pathology laboratory testing that incorporates genetic and molecular technologies needs further refinement, improved billing codes, and additional regulation before it can fulfill its potential to be a precise diagnostic tool.

That was the conclusion reached by a panel of distinguished physicians representing healthcare organizations, pharmaceutical giants, insurance companies, and the government at this year’s annual National Comprehensive Cancer Network (NCCN) conference.

Pathology Laboratory in an Ingestible Pill? Not Yet, But Maybe Sooner than You Think

Proteus Biomedical, Inc. prepares to launch a “smart pill” to remotely monitor how medication affects patients.

If some experts are correct, it won’t take long to create ingestible devices that are capable of conducting clinical laboratory tests within the body. These devices would transmit the laboratory test results to physicians over the Internet by using wireless technology.

As soon as 2011, Proteus Medical, Inc., of Redwood City, California, says it expects to introduce an ingestible device for managing heart disease and chronic disease to the clinical market. Proteus named this device the Raisin System and a popular term for this type of technology is “smart pill.”