According to this article, which goes into detail if you read the entire summary at the link below pretty much says Medicare was changing their system and way to reimburse and has not done so with some of the newer proprietary tests and so now those in question are just sitting there without getting paid.  We come back once again to IT INFRASTRUCTURE,  as I keep saying and elaborating on the fact that things take more time today due to complexities.  The code stacking explanation was interesting as if a test included portions of other steps, they were sort of rolled into the process. 

This affects LabCorp and Quest and who doesn’t seem to get a test done by one of them somewhere along the line.  This is a serious area as patients are getting bills and nobody can explain why they are not getting paid.  As it normally goes private insurers usually follow Medicare with their pricing and may add a little, but they have done nothing either with the exception of Palmetto, a company owned by Blue Cross Blue Shield who is a Medicare contractor and covers the state of California who have been working to create some kind of system but it is far from being complete or who knows how accurate, and it sounds like they stack up until all want their money.

Just like insurers the complexities with lab tests also cloud the waters and can hide things and make the cost of certain lab tests go up, as if nobody knows how to price it based on the work and labor provided, it sounds like a real estimate game here to where the labs can also call their price.  I find this interesting since we have HHS over thereimage telling all to “hurry up” with Health IT…you can clearly see where the technology and political disconnect lies here without having someone at the top who has some technology in their background, but that’s what we have.  I said back in 2009 that to have someone in charge of HHS without some substantial IT in their background would simply eat that person up and that’s what we have, nothing personal, just the way the world and technology works today.

Speed Up Rate of Change in Health IT?–“Short Order Code Kitchen Burned Down a Few Years Ago and There Was No Fire Sale”..IT Infrastructure Chance and Revisions Takes a Lot of ”Code”, “Time” and “ Most Importantly Money”

This is other things like the chatter about a Medicare Voucher system just grind on me as we keep hearing that in the news as being something that could be done, but it can’t as the budget would be huge, maybe second only to DOD and the time and inconvenience of disruptions would be astronomical, so we have digital illiterates on both sides of politics and we end up with these “fantasy battles of words” that in reality can’t be done.

This really hurts small labs too who are on the cutting edge with new proprietary diagnostic tests who don’t have a lot of money to operate with but represent knowledge we have never been able to test for before and could represent new lie saving treatments.  Anyway, we come back to the data and the math once again as that’s what has to function here with someone taking the front run.  Breast cancer and prostate cancer tests are right up at the front of some of this too.  Some may argue too that some of the tests are not necessary at certain points for certain patients.  Well the end result here is that someone has to provide some kind of guidelines even if they are not detailed where that might not be possible.  BD  


The Obama Administration has stopped paying the bills from hundreds of health care companies, and it has nothing to do with sequestration.

This is a story of bureaucratic mismanagement at the Centers for Medicare and Medicaid Services, and the harm it’s visiting on the diagnostic testing industry.

At issue is the way that Medicare reimburses everyone from the big laboratory companies such as the Laboratory Corp of America (LH:NYSE) and Quest Diagnostics Inc. (DGX:NYSE), to the molecular diagnostic labs inside academic hospitals, and especially smaller firms that make proprietary tests used by doctors to more effectively target treatments to patients with conditions like cancer.

The molecular diagnostics in question are used to screen for everything from genetic markers that predict disease to proteins that help diagnose illnesses and guide peoples’ response to treatments. These tests are transforming the treatment of cancer, among many other maladies.

The Medicare agency decided to change the way it reimburses these sorts of diagnostic tests. But it’s been slow to decide on its new approach. So in the absence of a policy, the Medicare program is simply not paying its bills.

But instead of coming up with a new system, CMS took the full year to do largely nothing. The agency sat on its hands. Then, only after winding down the clock, the agency announced that it would let the local Medicare carriers figure out what prices to assign to each of the different diagnostic codes (through a byzantine process called “gap filling”). In other words, Medicare punted.

Diagnostic tests were supposed to usher in an age of personalized medicine. Now they’re being actively priced controlled. And by a bureaucratic regime that can’t even figure out what prices they want to pay for these services.

http://www.forbes.com/sites/scottgottlieb/2013/03/27/medicare-has-stopped-paying-bills-for-medical-diagnostic-tests-patients-will-feel-the-effects/

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