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…)
Sep 2, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
News reports state that Anthem and Cigna have denied payment for some multigene panel tests, saying that the tests are unproven. Other insurers, such as UnitedHealthcare and Priority Health, pay for such tests but only for certain patients
A conflict is building between patients and health insurers over the reluctance among health plans to pay for new, expensive molecular diagnostic assays and genetic tests that clinical laboratory companies offer.
This conflict has caught the attention of the nation’s media. That is probably because it makes a great story, for example, to interview parents who can assert that their sick child suffered because their health insurance plan would not pay for a genetic test the parents believed would make a difference in their child’s clinical care. Of course, pathologists and medical laboratory professionals know that there are a significant number of expensive genetic tests being offered by various lab companies that lack extensive data to support their clinical efficacy. (more…)
Aug 26, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Digital Pathology, Instruments & Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Laboratory Testing, Management & Operations, News From Dark Daily
In provinces across Canada, health systems are dealing with limited budgets, growing populations, and the need to transition to personalized medicine
Medical laboratories in Canada have something in common with medical laboratories in most other developed nations. Demand for healthcare services exceeds capacity, even as the healthcare system struggles to find adequate funding. This puts pathology labs in a bind, since they are asked to test growing numbers of specimens even as budgets are flat or shrinking.
That means the biggest two challenges facing labs in Canada will be familiar to pathologists, clinical chemists and medical laboratory scientists in almost every other developed nation across the globe. One challenge is how to meet the steady annual increase in lab specimens that must be tested. The second challenge is how to do that additional testing even as government health systems are forced to trim budgets year after year. (more…)
Aug 21, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Smaller clinical laboratories and pathology groups should benefit from shift toward consumer-driven healthcare
High-deductible health plans (HDHP) are increasing in popularity as more consumers opt for lower annual premium costs in exchange for larger out-of-pocket expenses. This shift in health insurance could result in direct benefits for smaller clinical laboratories and pathology groups as more patients have a choice in where they purchase medical laboratory testing services.
From a policy perspective, employers and healthcare strategists hope that using HDHPs to engage consumers will help put market forces back into medicine. Because clinical laboratories and pathology groups increasingly find themselves excluded from provider networks, and fighting to keep access to patients, they should welcome the trend to consumer-driven healthcare.
A logical response to the HDHP trend would be for labs to begin posting their lab test prices on their websites. It would be equally useful to also post quality-performance and customer-satisfaction survey results to allow consumers to make informed choices about the labs they want performing their tests. (more…)
Jul 27, 2015 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, News From Dark Daily, Uncategorized
Payment reform unlikely to require legislation or raft of new regulations, but shift to value-based payment model will cost clinical labs and pathology groups
Today there is wide recognition in healthcare that the days of fee-for-service (FFS) medicine are numbered. But what is less certain is how fast government and private payers will introduce other reimbursement models, such as bundled payments and budgeted payments. Clinical laboratories and anatomic pathology groups likely will be the most impacted by this payment shift since their economics are driven by high volumes and FFS payment. (more…)
Jul 24, 2015 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations, Uncategorized
With cancer care costs soaring, will health insurers be asking whether the patient outcomes justify new and expensive diagnostic and therapeutic advances?
Medical laboratory companies offering expensive molecular tests for cancer and pharmaceutical companies that sell super-expensive cancer drugs are ready to hit the financial wall with payers and the healthcare system. That’s the opinion of Paul Keckley, Ph.D, a widely-read healthcare strategist.
Keckley warns that the cost of cancer care management is nearing a tipping point where the relative value of innovations may no longer outweigh the cost. In this new environment, Keckley expects pathologists, medical laboratory scientists, and others working in cancer care to face challenges over the cost-effectiveness of their diagnostic and therapeutic advances. (more…)
