Jul 18, 2011 | Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, News From Dark Daily
Recent federal court case and a columnist in the Weekly Standard illustrate how Boomers are ready to challenge existing Medicare laws they don’t like
Will the oldest Baby Boomers, now turning 65 years old this year, accept enrollment in the Medicare program or will they challenge it—as they have challenged many other institutions in American society over their lifetimes? News outlets are already reporting instances of Baby Boomers fighting to keep their existing private health insurance, for example.
If this is a trend that sets down deep roots, it can also trigger significant changes in the clinical laboratory testing marketplace. Were Baby Boomers to file lawsuits in federal courts that are settled in their favor, for example, it could pave the way for Boomers to retain private health insurance in lieu of enrollment in fee-for-service Medicare or the Medicare Advantage Plans.
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Jul 15, 2011 | Laboratory News, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
Document leak earlier this week pulls curtain back on potential cuts to Medicare/Medicaid spending
Spending cuts of between $334 billion and $353 billion over the next 10 years are on the table in the negotiations over the federal debt ceiling. The bad news for the clinical laboratory industry is that restoration of the Medicare patient co-pay for medical laboratory tests is not only on the list of proposed spending cuts, but represents a significant chunk of money—as much as $16 billion during the next decade!
Typical of beltway politics, it was only because of a leak that the list of proposed Medicare and Medicaid spending cuts became public knowledge. On Tuesday this week, Kaiser Health News was one of the first to report the leak of the documents. It also posted a copy of the briefing documents on its website.
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Feb 14, 2011 | Compliance, Legal, and Malpractice, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
CMS says it will take steps to rescind the final rule before its scheduled implementation on April 1, 2011
Clinical laboratories and pathology groups will welcome the news that the federal Centers for Medicare & Medicaid Services (CMS) will take steps to rescind the final rule that requires the physician’s signature be on all paper requisitions for medical laboratory tests ordered on behalf of Medicare patients. It means that implementation of the rule—now scheduled to become effective on April 1, 2011—will not happen if CMS officials act in a timely manner.
Dark Daily has learned that last Friday a conference call took place involving Jonathan Blum, Director of the Center for Medicare Management, and representatives from the American Association of Bioanalysts (AAB) and the American Clinical Laboratory Association (ACLA). During the conference call, Blum disclosed that a decision had been reached within CMS to rescind the final rule that would require physicians’ signatures on paper requisitions for medical laboratory tests. Apparently, CMS intends to take the steps necessary to rescind this final rule before its effective date of April 1, 2011.
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Dec 22, 2010 | Compliance, Legal, and Malpractice, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
Medicare Program Won’t Enforce the New Rule For At Least 90 Days
Yesterday brought welcome news for all clinical laboratories and pathology group practices in the United States. That’s because the Centers for Medicare and Medicaid Services (CMS) posted an announcement on its website that it would delay enforcement of the final rule requiring that physician’s signatures be on all paper requisitions for Medicare patients starting January 1, 2011. This includes laboratory test requisitions.
This rule was part of the Final Medicare Physician Fee Schedule Rule published in the Federal Register on November 29, 2010. In short, once enacted, the rule will require all paper requisitions sent to Medicare to have a doctor’s signature to be reimbursed. (more…)
Dec 1, 2010 | Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
Still No Medicare Quality Measures for Clinical Laboratories and Pathology Groups
Transparency in provider outcomes is moving one step forward and this time it’s a new bonus plan for Medicare Advantage plans. The Centers for Medicare and Medicaid Services (CMS) believes the enhancement will encourage lower performing plans to improve their quality of care.
Quality Measures Should Interest Medical Laboratory Managers
Pathologists and clinical laboratory managers will be interested to learn that, during the 3-year demonstration project, bonuses of 5% will be paid to Medicare Advantage plans that achieve a 5-star rating. Lesser bonuses will be paid to those plans that achieve three to four stars. A new twist is that this update also includes a new “low performer” icon to alert Medicare Advantage recipients of plans that earn less than three stars over a 3-year period.
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Jul 12, 2010 | Laboratory Pathology, Managed Care Contracts & Payer Reimbursement, Management & Operations
New Federal Mandate Will Make ACO-Based Provider Networks Responsible for Improving Quality and Cutting Costs
Pathologists and clinical laboratories are positioned to benefit from the provision in the Affordable Care Act of 2010 that is intended to reduce the cost of healthcare. It is the provision which authorizes the use of “accountable care organizations” (ACOs) and will be triggered in 2012.
Accountable care organizations are not yet a well-defined concept. ACOs are recognized to have some basic characteristics. First, an ACO is an integrated care network of providers with the ability to provide care to, and manage patients, across the continuum of care that should include different institutional settings, such as ambulatory care, inpatient hospital care, and even post-acute care.
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