Blog Posts by Date: Jul 2012

Unique Needs of Labs Make Shorter Filing Deadlines Punitive

  • July 31, 2012

It is no coincidence that payors are in a rush to reduce timely filing deadlines and tighten claims submission rules. With the roll out of the Affordable Care Act, payors are under pressure to reduce expenses and apparently some believe administrative obstacles are a good way to accomplish that. To kick the effort off, section 6404 of the...


Managed Care All Over Again?

  • July 23, 2012

89 new ACOs were announced last week and several private payors announced ACOs including Aetna in New Jersey, Cigna in California and BCBS of North Carolina. It is no coincidence that the payors that have been the most active with paring down their provider networks are first to announce their ACOs. Will private payor coordinated ACOs, where 20%...


Blue Cross/Blue Shield Plan Changes Beginning to Impact Patients, Providers

  • July 11, 2012

As BCBS plans roll out their strategies to eliminate the BlueCard plan, more and more diagnostic laboratories are finding themselves holding the bag after having provided medically necessary testing in good faith and accepting assignment from patients to file insurance claims on their behalf, only to find that the plans are paying the...


Hijacking the Concept of Value Based Pricing

  • July 9, 2012

Buyer beware. The promise of value based pricing is becoming synonymous with bundled pricing and utilization control as Healthcare Reform stakeholders are incentivized by short term gains to tackle a fee-for-service system that rewards provision of services rather than achievement of outcomes. In the race to contain healthcare costs, whether...


Billing Information Is Essential in New Era of Affordable Care

  • July 2, 2012

In light of the decision to effectively uphold the Affordable Care Act, the Supreme Court has set in motion perhaps the largest policy scramble in the history of health care. The business of health services will never be the same and the reverberations of the decision and the battle to repeal it will be felt for many years to come. A growing...