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 5, 2013 | Instruments & Equipment, Laboratory Instruments & Laboratory Equipment, Laboratory News, Laboratory Operations, Laboratory Pathology, Uncategorized
Separate research projects at University of Washington and in the United Kingdom are producing handheld diagnostic devices to accurately detect Malaria
Two new handheld, point-of-care test (POC) devices for malaria could save millions of lives in third-world countries. At the same time, these POC devices may lead to inexpensive alternatives for diagnosing common diseases in developed nations as well.
Clinical laboratory test developers see a big opportunity in developing assays to detect Malaria. That is because an estimated 200 million cases of malaria are diagnosed annually, resulting in the death of about 100 million people each year.
Recently, two organizations released news about the specific testing devices they have developed to detect malaria. One group is at the University of Washington in Seattle, Washington. The other group is NanoMal, a biotechnology company located in the United Kingdom. (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 10, 2013 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Uncategorized
A newspaper in San Francisco featured a story about the patient’s complaint about being overcharged thousands of dollars by the hospital for medical laboratory tests
Here’s how a community hospital that charges inpatient prices for clinical laboratory testing to a walk-up customer find itself at the center of a media news storm. In California, a newspaper trumpeted the story of an unhappy consumer stuck with a $4,316.55 bill for a panel of medical lab tests that a national lab would have performed for just $464, about 90% cheaper!
Cautionary Tale for Medical Laboratories and Pathology Groups
Price transparency is a major trend in healthcare and consumers are catching on quickly. This raises the stakes for any hospital, medical laboratory, and anatomic pathology group that is slow to respond to the growing number of consumers who now price-shop whenever they need clinical laboratory tests. (more…)
Feb 22, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Uncategorized
Issue does not directly affect clinical laboratories and pathology groups, but puts spotlight on some hospitals and physicians who frequently use these codes.
Could increased use of electronic health records (EHR) systems be causing more hospitals and physicians to commit fraud because of upcoding? That’s the assertion of certain federal health officials. They attribute the increased proportion of Medicare claims for more complex and more expensive services by some providers to be, in some part, acts of fraud.
Most pathologists and clinical laboratory managers will notice the irony in these allegations that providers are upcoding services to Medicare patients in fraudulent ways. After all, the federal government is currently paying billions of dollars in financial incentives to encourage providers to implement and use certified EHR systems with the goal of lowering healthcare costs, while improving patient outcomes.
OIG Audit Findings Are Source of Fraud Allegations
Insinuations of provider fraud came after the public learned of findings of an audit done by Health and Human Services’ Office of Inspector General (OIG). The OIG determined that payments for more complex Level 5 E/M services increased by 21% between 2001 and 2010. During that same period, payments for medium-complexity patient services decreased by 11%.
For all of 2010, the Centers for Medicare and Medicaid Services (CMS) paid out $33.5 billion for E/M billings. This was about one-third of Medicare Part B payments for physician services. These numbers were part of a story published in Modern Healthcare.
Now that much larger numbers of physicians and hospitals are using electronic health record (EHR) systems, Medicare has noticed a steady increase in the proportion of claims submitted at higher and more complex codes, increasing reimbursement. In response to one federal government audit, Kathleen Sebellius, Secretary of Health and Human Services (r) and Attorney General Eric Holder (l) held a joint press conference to announce to healthcare providers that there would be stricter audits of providers who are using billing codes for complex patient visits with greater frequency. (Photo by Manuel Balce Ceneta, copyright Associated Press.)
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Jan 16, 2013 | Instruments & Equipment, Laboratory Hiring & Human Resources, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Management & Operations, Uncategorized
Pathologists and clinical laboratory managers take note—this peptide chip microarray may have a role in point-of-care testing
At the heart of a new point-of-care technology is a prototype silicon chip that contains up to 9,000 peptides and allows real-time analysis in just minutes. Researchers say this technology can significantly reduce the time-to-answer when compared to existing clinical laboratory testing technologies.
This new prototype silicon chip is an on silico peptide microarray. It could help researchers better understand how proteins interact in the body. In turn, that will lead to improved diagnoses of numerous diseases. (more…)
