Jul 26, 2013 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations, Uncategorized
Clinical laboratories and pathology groups may want to review the prices they charge insured patients versus uninsured patients
There is a certain irony in the fact that hospitals and other medical providers typically charge patients without health insurance as much as three times what they charge Medicare or an insured patient. This situation is getting increased media scrutiny, which is one reason why clinical laboratories and pathology groups may want to review their own policies for charging patients without health insurance.
One good study on prices charged to self-pay patients was conducted by Gerard Anderson, Ph.D., a health economist at the Johns Hopkins Bloomberg School of Public Health. His study was funded by the Henry J. Kaiser Family Foundation and published in the May-June 2007 journal Health Affairs.
Anderson analyzed 2004 hospital billing data. He concluded that the gap between rates charged self-pay and insured patients has grown substantially since the mid-1980s. “In the 1950s, the uninsured and poor were charged the lowest prices for medical services. Today they pay the highest prices…,” wrote Anderson, noting that self-pay charges often reflect the hospital’s “chargemaster” prices–the top prices used to negotiate discounts with insurers. (more…)
Jul 10, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Sales and Marketing, Managed Care Contracts & Payer Reimbursement, Management & Operations, News From Dark Daily
High Co-pays for Lab Tests May Create a Collection Nightmare for Clinical Laboratories
As new facts about the prices of premiums and the amount of patient co-pays for California’s health information exchange—called Covered California—are published, the news is not likely to be favorable for clinical laboratories and anatomic pathology groups in the Golden State.
Of particular note is that Covered California has published a requirement that patients will be charged a $35 co-pay for medical laboratory testing. Some lab industry executives have pointed out that it will be a challenge to collect these co-pays. They expect labs will incur higher costs attempting to collect these co-pays while at the same time seeing a substantial increase in levels of bad debt. However, all of this will not happen until 2014, when Covered California begins providing health insurance coverage.
For one category of insured beneficiaries, there is a bit of good news. Insurance exchange premiums for individuals not covered by employer health plans will be lower than previously expected. Covered California will charge, on average, $321 per month on average for the “Silver,” medium-tier plan, noted Peter V. Lee, Executive Director of Covered California, in a report published by the Wall Street Journal. (more…)
Jul 3, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Digital Pathology, Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations, Uncategorized
Research study shows opportunity for clinical laboratories to help client physicians get more value from their electronic health record systems
For the majority of physicians in the United States, implementation of an electronic health record (EHRs) system in their practice may turn out to be a money-losing proposition. That is one prediction made by researchers at the University of Michigan (UM), based on a study they conducted.
Among other things, these findings indicate that progressive clinical laboratories and pathology groups have the opportunity to leverage the interface between their laboratory information system (LIS) and the client physician’s EHR to deliver added value. That’s because pathologists, Ph.D.s, and laboratory scientists know many ways that physicians can improve how they order medical laboratory tests and act upon the results of those tests.
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Jun 26, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations
Complying with this standard will help reduce errors by improving specimen handling and tracking, and also reduce lab costs by boosting accuracy and quality.
Clinical laboratories have about nine months to comply with a new standard for bar code labels. The deadline for compliance to AUTO12-A, Specimen Labels: Content and Location, Fonts, and Label Orientation, is April 29, 2014.
While compliance next year will not affect a lab’s accreditation, in the coming years accrediting bodies, such as The Joint Commission and the College of American Pathologists are expected to require medical laboratories to comply with this bar code label standard.
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May 28, 2013 | Coding, Billing, and Collections, Laboratory News, Managed Care Contracts & Payer Reimbursement, Management & Operations
Giving physicians Information on the price of medical laboratory tests at the time of order decreased overall use of such tests by about 9%, researchers said.
Physicians order fewer clinical laboratory tests when they know how much they cost, according to a recent study at the Johns Hopkins University School of Medicine.Those findings are good news for hospital-based pathologists who must often respond to physicians who order expensive esoteric tests that are inappropriate for the patient’s condition or lack documentation as to clinical utility.
The study results show another dimension to the power of transparent pricing in healthcare because it demonstrates that physicians are willing to take cost into consideration when deciding what clinical laboratory tests they should order. Some experts believe that publishing price information on the costs of care empowers consumers to shop for the best price, thus helping to reduce the overall cost of healthcare.
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May 22, 2013 | Coding, Billing, and Collections, Laboratory Hiring & Human Resources, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations
Smaller community laboratories serve many of the nation’s nursing homes and long-term care facilities, and ongoing medical lab fee cuts are having major negative consequences
DATELINE: LAS VEGAS, NEVADA—Last week, the National Independent Laboratory Association (NILA), in conjunction with the Association of American Bioanalysts (AAB), conducted its annual conference here. It was a useful snapshot on the state of health for independent community lab companies, particularly given the different reimbursement environment for clinical laboratory testing.
NILA’s members are primarily community clinical laboratories. They generate revenue anywhere from $1 million per year to around $100 million per year. It is believed that there are between 150 and 200 of these types of lab companies across the United States. Further, within the towns and cities they serve, these are often the only medical laboratory organizations that fill important testing niches that were abandoned years ago by the national public lab companies. (more…)
