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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Collecting from Patients May Get Tougher When New ACA Financial Rules for Non-profit Hospitals Became Effective January 1, 2014

The IRS is authorized to strip tax-exempt status from ‘willful and flagrant’ violators of ACA financial rules; pathologists and clinical laboratory managers should take notice

Hospitals and other providers already find it more difficult to collect larger amounts of money from patients who have high deductible health plans (HDHPs). That degree of difficulty increased on January 1, 2014. That’s the date when new regulations of the Affordable Care Act (ACA) kicked in that govern how hospitals can collect money from patients or extend financial aid to them.

Non-profit hospitals need to pay attention to the new requirements set forth by the ACA law. It is likely that these new rules will affect most hospital laboratory managers and hospital-based pathology organizations. That’s because these new rules will affect six out of 10 of the nation’s hospitals. (more…)

To Handle Increased Bad Debt by Patients in High-Deductible Health Plans, Hospitals Are Offering Loan Programs

Even clinical laboratories and pathology groups are reporting increased patient bad debt because more patients have high annual deductibles, often $5,000 or more

Hospital executives are anticipating a deluge of new patient debt associated with a dramatic increase in high-deductible health plans. Some hospital systems have even launched loan programs to help patients pay for their share of the cost for care provided and to stem the rising tide of uncollectible patient debt.

Patient Bad Debt Trend Should Be Watched by Clinical Lab Managers

It is important for clinical laboratory managers and pathologists to understand that these actions by hospitals to address bad debt is a reminder that medical laboratories will have a similar problem of collecting monies due to them from patients who have high deductibles and will need to pay 100% of the cost of their lab testing. (more…)

Vanderbilt University Medical Center Forms Nation’s Largest Clinically Integrated Network that includes Its Own Health Insurance Offering

Clinically integrated networks is one market trend in response to shift away from fee-for-service payment and toward value-based provider reimbursement

One fast-developing trend is that of academic centers forming integrated networks with various providers within a community and a surrounding region. This is related to a movement to establish accountable care organizations (ACOs). But it is also a response to actions by payers to narrow their networks and exclude high-cost providers, such as academic centers.

This business model has a mutual goal. Each integrated network is anchored by an academic medical center and is designed to foster closer interaction between the academic subspecialists and the wider clinical community. For pathologists and clinical lab managers, such integrated provider networks may often encourage participating physicians to send their reference and esoteric medical laboratory test referrals to the academic center and not to the physicians’ primary laboratory provider. (more…)