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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Medicare Program Officials Affirm Meaningful Use Stage Three to Continue Even As the Agency Moves to Implement MACRA’s Value-Based Payment Law

Clarification comes just a week after one CMS official had discussed the end of Meaningful Use at a conference in San Francisco

Talk about mixed messages! Is the federal Meaningful Use (MU) program about to end? Or is it going to continue and evolve in significant new ways?

Alert pathologists and clinical laboratory executives may have picked up on the conflicting statements about the future plans for Meaningful Use that have been made in recent weeks by certain officials from the Centers for Medicare and Medicaid Services (CMS).

Because thousands of hospitals and hundreds of thousands of physicians have made substantial capital investments in electronic health records to qualify for federal incentives, any major change to the Meaningful Use requirements will have broad consequences.

Medical laboratories have a big stake in this issue as well, since they must invest substantial money into creating the interfaces needed to connect their labs’ laboratory information systems (LIS) to the EHRs of client hospitals and physicians. (more…)

Clinical Laboratories, Pathology Groups Being Squeezed by ‘Balanced Billing’ Dispute That Puts Providers, Hospitals, and Insurers at Odds

Health plans increasingly refuse to pay out-of-network providers who they claim often inflate their charges, leaving patients with unexpected medical bills 

As health insurers narrow their provider networks in an effort to lower costs and hold down premiums, clinical laboratories and anatomic pathology groups may increasingly be designated as out-of-network providers and find themselves struggling to get paid.

This is particularly true in cases where a hospital is in-network and its hospital-based physicians—including its pathologists—are out-of-network for that same insurer. Following their discharge from the hospital and their insurer’s payment of the hospital bills, patients are surprised to get bills from the hospital-based physicians.

It is a problem that won’t go away soon. That’s because it is increasingly common for patients who are being treated in an in-network hospital to unknowingly receive care from out-of-network doctors, such as pathologists, anesthesiologists, emergency physicians, hospitalists and radiologists, who may not participate in the same plan networks as the hospital does. (more…)

Many Pathologists Participate in Medicare’s Quality Reporting and e-Prescribing Programs, but 40% of Providers Opt for Penalties over Compliance

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…)