Billing News Sep 2018



Highmark Health to Evaluate Biocept Liquid Biopsy Platform

  • September 6, 2018

Highmark Health announced it will study the clinical and economic impact of Biocept's Target Selector liquid biopsy in patients with non-small cell lung cancer. The 12-month evaluation is being conducted through Highmark's Vital Innovation Program. The results will be used to determine whether Target Selector can improve the molecular profiling...

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Alphabet's $375 million investment in Oscar Health will expand insurer into Medicare Advantage

  • September 6, 2018

Today, we are announcing Alphabet's plans to invest $375 million into Oscar Health," said Mario Schlosser, co-founder and CEO of Oscar Health. "Oscar will accelerate the pursuit of its mission: to make our healthcare system work for consumers. We will continue to build a member experience that lowers costs and improves care, and to bring Oscar to...

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BCBS NC inks value-based deal with UNC Health, driving down ACA premiums

  • September 6, 2018

BCBS NC announced the changes after its Affordable Care Act rates were approved by the state on Wednesday. Average premiums on ACA plans will drop 4.1% thanks, in large part, to the deal with UNC Health, BCBS spokesman Austin Vevurka told FierceHealthcare.  The deal also represents a distinct push toward value-based care.

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CMS physician fee schedule: Will hospital labs be excluded again from PAMA price reporting?

  • September 6, 2018

IN A PROPOSED RULE ISSUED JULY 12, the federal Centers for Medicare and Medicaid Services continued to push an interpretation of the Protecting Access to Medicare Act of 2014 (PAMA) that will reduce still further what CMS pays for clinical laboratory tests.  CMS once again said that it interprets PAMA in a way that excludes hospital...

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New Aetna, UHC Contracts Create Openings for Labs

  • September 6, 2018

“Payers have always had gaps in their coverage for clinical lab services,” Stonecypher said. “Even when Quest and LabCorp had their previous contracts with UHC and Aetna, there were gaps. So, there also will be gaps in patient access after these contracts become effective on Jan. 1. “Each one of those gaps is an opportunity for a regional...

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Louisiana uninsured rate cut in half due to Medicaid expansion

  • September 6, 2018

Louisiana's Medicaid expansion cut the state's uninsured rate among adults by half in two years, plummeting from more than 22% to just over 11%.  The Edwards administration expected 350,000 Louisianans to benefit from the expansion, and data released this week suggests that estimate is on track.

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UnitedHealth Group’s MedExpress and Walgreens Boots Alliance Initiate Pilot Program to Put Urgent Care Centers in Walgreens Pharmacies

  • September 6, 2018

Motivated by consumer demand for convenient, high-quality healthcare, the urgent care market in the United States continues to grow. This trend will eventually influence clinical laboratories and anatomic pathology groups seeking to service these providers. It will be a dynamic market as new participants and mergers compete for leverage in this...

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MolDX Local Coverage Determination (LCD) Updates

  • September 6, 2018

The following A/B MAC LCD(s) were revised: MolDX: Genetic Testing for Lynch Syndrome L35024 MolDX: BRCA1 and BRCA2 Genetic Testing L36082 MolDX: Prometheus IBD sgi Diagnostic Policy L37260 To view the LCD(s), go to www.PalmettoGBA.com/jma/lcd or www.PalmettoGBA.com/jmb/lcd, www.PalmettoGBA.com/jja/lcd, and www.PalmettoGBA.com/jjb/lcd....

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