Aug 24, 2011 | Coding, Billing, and Collections, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
“Bundled Payments for Care Improvement Initiative” will be voluntary for hospitals, physicians, and other providers, including medical laboratories
Yesterday, Medicare officials took the first steps to implement a program for bundled Medicare payments by issuing documents which describe how this program would work. At least two of the four models for bundled reimbursement will include clinical pathology laboratory tests as part of the bundled care arrangement.
Clinical laboratory managers and pathologists will want to pay close attention to this development. The Centers for Medicare and Medicaid Services (CMS) titled this new effort the “Bundled Payments for Care Improvement Initiative.” It is a voluntary program. Only those providers who submit proposals and bids which are accepted will be paid through this program. The goal is to encourage different providers to collaborate on the care of a patient. Each of the four models for bundled healthcare has a slightly different payment arrangement.
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Jul 6, 2011 | Laboratory News, Laboratory Pathology
Medicare officials seeking public comment during the July 18 meeting
Changes in how the Medicare program will reimburse pathology groups and clinical laboratories for genetic tests and molecular diagnostic assays will be one of the important topics at an upcoming meeting in Baltimore on July 18, 2011. The federal Centers for Medicare and Medicaid Services (CMS) will conduct the meeting at its headquarters and is asking for public comment as it develops coverage guidelines and reimbursement levels for the 2012 laboratory test fee schedule.
As many pathologists and medical laboratory managers know, a major effort to revise and update CPT codes for genetic and molecular tests performed by clinical laboratories is moving forward. The goal is to recognize advances in this field of diagnostic testing by updating the CPT codes. Another goal, widely supported by private health insurance plans, is to reduce the use of “code stacking” as the primary coding and claims methodology that must be used for a large number of genetic and molecular medical laboratory tests.
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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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Oct 1, 2010 | Laboratory Pathology, Management & Operations
No clinical pathology laboratories are known to have ceased serving Medicare and Medicaid patients
It’s widely acknowledged by physicians and other providers that Medicaid reimbursement in many states is significantly less than the true cost of providing the service. There are also many types of health procedures where Medicare reimbursement fails to fully reimburse the provider. Thus, it is an important signal when two prominent healthcare organizations announce that—in certain locations and for certain services—they will no longer serve Medicaid or Medicare patients.
Pathologists and clinical laboratory managers will soon see an increasing number of healthcare providers decide to cease serving Medicare and/or Medicare patients. Just in the past 12 months, such nationally respected healthcare organizations as Walgreens and Mayo Clinic have announced that, in certain markets, they will no longer serve new Medicare and/or Medicaid patients. The details of these decisions are revealing.
In the State of Washington, earlier this spring, Walgreens (NYSE:WAG) announced that all 121 of its pharmacies in the state would no longer accept new Medicaid patients. This followed an earlier announcement by the Bartell Drugs chain that its 44-store chain would also no longer serve new Medicaid patients in Washington State.
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May 25, 2010 | Coding, Billing, and Collections, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
Health insurers not eager to establish coverage for new molecular diagnostic assays
Navigating the pathway to successful commercialization of new genetic tests and molecular diagnostic assays has proven tricky. While scientists work quickly to bring new and better clinical laboratory testing tools to the market, health insurers work at a much slower pace to issue coverage guidelines and establish reimbursement for these new diagnostics tests.
“Successfully moving a genetic test from the research bench to the clinical laboratory takes much more than an understanding of the science,” stated Rina Wolf, Vice President of Commercialization Strategies for Consulting and Industry Affairs, XIFIN Inc., of San Diego, California. “Competition for coverage and reimbursement by health insurers is fierce. Often, the molecular diagnostic tests that win the best coverage decisions by payers are those proprietary tests backed by companies and laboratories with the most effective business plans.”
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