Jul 11, 2014 | Compliance, Legal, and Malpractice, Digital Pathology, Instruments & Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
The majority of the nation’s hospitals and physicians now use electronic health records and most of these EHR users are already exchanging clinical data with regional HIEs
Pathologists tracking the adoption of EHR systems by hospitals and physicians will be interested to learn that, according to the federal government, more than 80% of hospitals and 50% of physicians now use these products. It is also reported that growing numbers of providers are exchanging data with health information exchanges.
Clinical laboratories and anatomic pathology groups have a big stake in these developments. Medical laboratory test data is an essential component to every patient’s permanent health record, which is why it is important for every lab to have interfaces with the HIEs serving their communities and regions.
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Jan 22, 2014 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory News, Laboratory Operations, Laboratory Pathology
Statistics indicate that inpatient admissions and revenues are falling nationally, a development that affects clinical laboratories in hospitals and health systems
One important trend that directly impacts the medical laboratories of hospitals and health systems is the falling rate of inpatient registrations seen nationally in recent years. What exacerbates this trend is the fact that many payers are cutting the prices they pay for certain inpatient services.
Collectively, these two developments mean less inpatient revenue for many hospitals and that often translates into reduced budgets for the clinical laboratories.
But that is not the whole story concerning inpatient revenue. Spurred by the Affordable Care Act (ACA) and other market developments, payers now want to shift reimbursement away from fee-for-service to new models of reimbursement. This includes capitation or bundled payment models. (more…)
Oct 16, 2013 | Laboratory Hiring & Human Resources, Laboratory Instruments & Laboratory Equipment, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Sales and Marketing, Management & Operations
Recent hospital mergers are creating super-sized health systems that immediately gain leverage over insurers when negotiating managed care contracts
Experts say the nation is experiencing its biggest surge in hospital mergers in more than a decade. Moreover, this latest wave of deals is creating supersized hospital systems that are expected to dominate healthcare and possibly lead to higher healthcare costs.
The ongoing consolidation of hospital ownership means further consolidation of the hospital laboratories that find themselves merged into larger health systems. That will have both good and bad consequences for pathologists and medical laboratory managers working within these organizations. (more…)
Sep 27, 2013 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology
Pathology groups and clinical laboratories should be taking steps to collect from patients at the point of care, as a key strategy to minimize patient bad debt
Here’s some bad news for hospital Chief Financial Officers (CFOs) and an early warning for clinical laboratory administrators. A rising number of patients with high deductible health plans (HDHPs) are unable to pay their medical bills.
Enrollment in HDHPs has soared in recent years because more employers and health insurers have adopted these plans. HDHPs also are called consumer-directed health plans (CDHPs) and typically have annual family deductibles of between $5,000 and $10,000. (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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