Latest Blog


Dec 14, 2019

The field of laboratory medical billing is unlike physicians, hospitals, or DME billing specialties. It is centered on a very specific set of CPT codes. The codes used by a lab includes services that are used to evaluate specimens obtained from a patient sample. It won’t be wrong to say that labs run labs. And, that’s what they bill for. Laboratories carry out testing procedures for samples provided by a doctor who orders them. Once it is done, results are handed over to the doctor, who then uses these results to suggest and finalize treatment procedures for his patients. Lab samples are required to be prepared and screened by qualified laboratory personnel with the help of a pathologist who assumes the risk of interpretation. This means that a majority of professionals working in a lab and running the tests are lab technicians. In a normal lab set-up, tests are conducted […]

What is the reason behind United Healthcare & Aetna closing their panels for new labs across the major states?

Sep 5, 2019
reason behind united healthcare aetna

UHC is one of the biggest health insurances in the US. Quest Diagnostics on January 01, 2019 took over to become the preferred in-network provider for around 49M UHC enrollees. Aetna too, underwent a similar culling of in-network labs a few years back when a contract with LabCorp was signed. Since the inception of these events, smaller and regional labs along with some hospital lab outreach programs have been filling the gap In UHC’s network. This only takes place where LabCorp and Quest are not present. Following the lead, Horizon BCBS NJ also went on to include LabCorp and Quest into its network thereby, closing panels for new labs across all the major states. What can be the possible alternatives for out-network Labs? “There are indeed a series of procedure that a lab can follow when declared out-of-network by a health plan. But it’s best to be prepared than to […]

Genetic Testing

Sep 5, 2019

Genetic testing involves lab tests to identify changes in chromosomes, genes, and proteins. The results of a genetic test help detect genetic issues, disorders, conditions and rule out the chances of developing or passing them on to the next generation. Over 2000 genetic tests are in use at present and more are expected to be introduced soon. Some of the common methods of genetic testing include: Chromosome Testing These tests help analyze the long lengths of DNA and check for large scale genetic changes, For example, the generation of an extra copy of chromosome to cause genetic modification. Biochemical Testing These type of genetic tests are used to study the amount and activity level of proteins. Any abnormalities indicate changes to the DNA that would result in a genetic disorder. Diagnostic Testing These tests are used to identify diseases in a patient. The findings through these diagnostic tests help in […]

Procedural win for ACLA in pama case appeal

Sep 5, 2019

The U.S. Court of Appeals for the District of Columbia, sued the federal Department of Health and Human Services (DHHS) on July 30, leading to a significant procedural win for the ACLA (American Clinical Laboratory Association). In the appeal on the case against DHHS Secretary Alex Azar last year, the court announced that ACLA is entitled to challenge what it calls DHHS’s harmful regulatory overreach, when last year only, it implemented the Protecting Access to Medicare Act (PAMA) norms. Under the PAMA, the CMS (Centre for Medicare and Medicaid Services) deducts what it pays clinical labs by 10% and then again by 10% this year. Another 10% cut will be effective from January 01 of the coming year, followed by three more years of 15% cuts from January 1, 2021. Intent of the Congress ACLA had challenged the PAMA implementation on the grounds of CMS not following Congress’ intent, as […]