Jul 9, 2014 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Scheduled to launch in early 2015, the Health Care Cost Institute’s free online tool will give consumers access to data on provider prices and quality
It’s a significant sign of the times when three of the nation’s biggest health insurance companies agree to share data on healthcare prices and utilization specifically so that consumers can access this information. This will advance price transparency. It will also put more pressure on clinical laboratories to make it easy for consumers to see the prices of medical laboratory tests in advance of services.
This new price-transparency project includes Aetna (NYSE: ATE), UnitedHealthcare (NYSE: UNH), and Humana (NYSE: HUM). The three health insurers are partnering with the Health Care Cost Institute (HCCI), a nonprofit organization that maintains a database on healthcare cost and utilization.
The insurers will share healthcare price data. HCCI plans to provide the general public free, online access to this information, beginning in early 2015. (more…)
Jun 16, 2014 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations
Similar to Oscar Healthcare in New York, this California-based enterprise technology company offers services to make it easy for individuals to see providers’ prices, including medical laboratory test prices
Another company has entered the marketplace with their unorthodox business model to support health insurance programs. One cornerstone feature is a tool that enables both employers and beneficiaries to see the prices of different providers.
This young player in the health benefits marketplace is Castlight Health (NYSE: CSLT). Based in San Francisco, it was founded in 2008. One aspect of Castlight that pathologists and clinical laboratory managers may find particularly interesting is its price transparency tool. (more…)
Feb 15, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology
Raising the out-of-pocket costs for Medicare beneficiaries with Medigap policies not likely to be favorable for medical laboratories
If federal officials have their way, Medicare beneficiaries with comprehensive Medigap polices are likely to pay a greater share of the cost of their medical care. The goal is to reduce use of unnecessary medical services and save Medicare money.
For clinical laboratories and anatomic pathology groups, this may not be a welcome development. That’s because any requirement for labs to collect more money directly from Medicare beneficiaries will raise the cost of billing and collections—even as medical laboratories also see a rise in bad debt from Medicare beneficiaries, who are not accustomed to paying any money out-of-pocket for most of their medical laboratory tests.
May Be Some Good News for Pathologists
However, there is some good news for pathologists and clinical laboratory managers in this story. A credible source has warned the federal government that increasing the Medicare beneficiary’s costs will not reduce unnecessary utilization of healthcare services. Nor will it save the Medicare program any money. In fact, such actions may have the opposite effect!
The government is considering requiring higher out-of-pocket cost sharing from the 9 million seniors with Medigap policies to cut down on use of unnecessary medical services. The National Association of Insurance Commissioners contend, however, that this would raise Medicare costs over time. (Graphic by Kaiser Health News)
(more…)
Jan 2, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology
MGMA-ACMPE hopes survey data ultimately reduces distractions and resource diversion for physicians—including pathologists—that result from interactions with payers
When physicians and their practice managers are surveyed about their satisfaction with health insurers, the Medicare program outscores all private health insurers. This was just one finding of an annual survey on this topic conducted by Medical Group Management Association-American College of Medical Practice Executives (MGMA-ACMPE).
Certainly pathologists have their opinion about the service levels of different health insurers. However, MGMA’s survey does not break out physician satisfaction by different medical specialties. The survey findings reveal that most physicians are neutral or dissatisfied to some degree when queried about different aspects of service provided by Medicare and private health insurers. (more…)
Jun 7, 2007 | Laboratory News, Managed Care Contracts & Payer Reimbursement
Laboratory Corporation of America (NYSE: LH) announced yesterday that it had executed a multi-year clinical laboratory services contract renewal with CIGNA HealthCare (NYSE: CI). An important facet of the renewal, noted in LabCorp’s press release, is that “LabCorp will no longer be contractually restricted from marketing that the Company is a fully participating, in-network provider to CIGNA HealthCare for all services in all major markets.”
“This agreement is important because we will no longer be prohibited from marketing to doctors and patients that we are a participating, in-network provider to all CIGNA HealthCare members and plans in all major markets,” said David P. King, President and Chief Executive Officer of LabCorp. “We welcome the opportunity to compete for CIGNA HealthCare business on a level playing field with all other contracted laboratories. Of course, CIGNA HealthCare’s participating physicians may continue to send all of their work to LabCorp, giving choice to those physicians who prefer using a single high-quality, full-service laboratory.”
What Dark Daily finds notable about this contract renewal is that it is not exclusive to LabCorp, so Quest Diagnostics Incorporated (NYSE: DGX) continues to be a provider for CIGNA HealthCare. CIGNA HealthCare membership grew by 3% in 2006, to 9.4 million beneficiaries. It is experiencing rapid growth in consumer-directed healthcare plans (CDHPs), with enrollment in CDHPS growing from 100,000 members in 2005 to over 250,000 in 2006, according to Cigna’s 2006 Annual Report. Cigna is also greatly expanding its membership outside of the United States. This is another example of how healthcare is globalizing.
This is also the first time since last fall that a national health insurer, when renewing national contracts for laboratory services, has not entered into an exclusive agreement with one laboratory company. In October 2006, United Healthcare (NYSE: UNH) granted an exclusive national contract to LabCorp. In May of this year Aetna (NYSE: AET) selected Quest Diagnostics to be its exclusive national laboratory provider. At the end of 2006, UnitedHealth and Aetna had 26 million and 15.4 million members, respectively.
Related Articles from Dark Daily:
LabCorp Ousted from Aetna’s National Contract
Judging the UnitedHealth Decision to Drop Quest Diagnostics in Favor of LabCorp
United Health Disrupts the National Contract Status Quo Between the Two Blood Brothers
