Menu
Home
Forums
Forums
Quick Links
Search Forums
Recent Posts
job listings
catering
whistleblower info
legal help
advertise on CP
submit press release
Menu
Log in
Sign up
Search titles only
Posted by Member:
Separate names with a comma.
Newer Than:
Search this thread only
Search this forum only
Display results as threads
More...
Useful Searches
Recent Posts
Cafepharma Message Boards | Pharma Sales, Device Sales, Lab Sales
Home
Forums
>
Laboratory/Diagnostic Sales
>
Laboratory/Diagnostic Sales General Discussion
>
List of Labs with hospital billing schemes
>
Reply to Thread
Name:
Verification:
Answer the above question:
(
CustomImgCaptcha
By
Surrey Forum
)
Message:
<p>[QUOTE="anonymous, post: 5946131"]The technical term for these programs is "outreach." HOPD stands for hospital outpatient department. In my experience people who refer to these programs as HOPD don't understand what's going on. Any hospital executive would laugh if you called their outreach program HOPD.</p><p><br /></p><p>Properly run Hospital Outreach programs are not new, nor are they "shady." It's extremely common place for physicians to send their lab work to a local hospital. Additionally it's the standard, and expected, when you're employed by a hospital. Most everything regarding outreach is spelled out in the Medicare Claims Processing Manual. There's also specific language in the Managed Care contracts between payors and hospitals that needs to be looked at. Some permit the practice, others do not.</p><p><br /></p><p><a href="https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html" target="_blank" class="externalLink ProxyLink" data-proxy-href="https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html" rel="nofollow">https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html</a></p><p><br /></p><p>There's a right way to do these, and of course, as we've seen time and time again, a wrong way. The fundamental issue with nearly all these programs is that these independent laboratories have been engaging in Under Arrangements with all these hospitals. In other words, an independent lab was processing the specimen and then billing "under an arrangement" through the hospital contracts. While this is not explicitly prohibited by CMS, most managed care contracts prohibit the act.</p><p><br /></p><p>Read the Campbellton Graceville lawsuit. Read the Mission lawsuits. The basis for their claims of fraud is that the testing was never performed at the hospital.</p><p><br /></p><p>Just like any lab there's nothing wrong with a hospital going out and hiring a sales team to sell doctors on their laboratory. It's been going on for years, and will continue to do so into the future. Some overly aggressive people got greedy and did things the wrong way and unfortunately gave a bad name to an old, compliant and profitable business practice.</p><p><br /></p><p>Just take a look at the news. Quest and Labcorp have been buying up outreach programs for awhile now.</p><p><br /></p><p><a href="http://newsroom.questdiagnostics.com/2017-09-29-Quest-Diagnostics-Completes-Acquisition-of-the-Outreach-Laboratory-Services-of-Two-Hartford-HealthCare-Hospitals-in-Connecticut" target="_blank" class="externalLink ProxyLink" data-proxy-href="http://newsroom.questdiagnostics.com/2017-09-29-Quest-Diagnostics-Completes-Acquisition-of-the-Outreach-Laboratory-Services-of-Two-Hartford-HealthCare-Hospitals-in-Connecticut" rel="nofollow">http://newsroom.questdiagnostics.com/2017-09-29-Quest-Diagnostics-Completes-Acquisition-of-the-Outreach-Laboratory-Services-of-Two-Hartford-HealthCare-Hospitals-in-Connecticut</a></p><p><br /></p><p><a href="http://www.businesswire.com/news/home/20170110005755/en/LabCorp-Acquire-Assets-Mount-Sinai-Health-System" target="_blank" class="externalLink ProxyLink" data-proxy-href="http://www.businesswire.com/news/home/20170110005755/en/LabCorp-Acquire-Assets-Mount-Sinai-Health-System" rel="nofollow">http://www.businesswire.com/news/home/20170110005755/en/LabCorp-Acquire-Assets-Mount-Sinai-Health-System</a></p><p><br /></p><p>There are good eggs out there. And you can make an outstanding income working with the right program. Just do your due diligence and make sure you're not working with any program utilizing under arrangements (not performing work at the hospital), taking specimens too far away from the hospital and keeping the charges realistic.[/QUOTE]</p><p><br /></p>
[QUOTE="anonymous, post: 5946131"]The technical term for these programs is "outreach." HOPD stands for hospital outpatient department. In my experience people who refer to these programs as HOPD don't understand what's going on. Any hospital executive would laugh if you called their outreach program HOPD. Properly run Hospital Outreach programs are not new, nor are they "shady." It's extremely common place for physicians to send their lab work to a local hospital. Additionally it's the standard, and expected, when you're employed by a hospital. Most everything regarding outreach is spelled out in the Medicare Claims Processing Manual. There's also specific language in the Managed Care contracts between payors and hospitals that needs to be looked at. Some permit the practice, others do not. [URL]https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html[/URL] There's a right way to do these, and of course, as we've seen time and time again, a wrong way. The fundamental issue with nearly all these programs is that these independent laboratories have been engaging in Under Arrangements with all these hospitals. In other words, an independent lab was processing the specimen and then billing "under an arrangement" through the hospital contracts. While this is not explicitly prohibited by CMS, most managed care contracts prohibit the act. Read the Campbellton Graceville lawsuit. Read the Mission lawsuits. The basis for their claims of fraud is that the testing was never performed at the hospital. Just like any lab there's nothing wrong with a hospital going out and hiring a sales team to sell doctors on their laboratory. It's been going on for years, and will continue to do so into the future. Some overly aggressive people got greedy and did things the wrong way and unfortunately gave a bad name to an old, compliant and profitable business practice. Just take a look at the news. Quest and Labcorp have been buying up outreach programs for awhile now. [URL]http://newsroom.questdiagnostics.com/2017-09-29-Quest-Diagnostics-Completes-Acquisition-of-the-Outreach-Laboratory-Services-of-Two-Hartford-HealthCare-Hospitals-in-Connecticut[/URL] [URL]http://www.businesswire.com/news/home/20170110005755/en/LabCorp-Acquire-Assets-Mount-Sinai-Health-System[/URL] There are good eggs out there. And you can make an outstanding income working with the right program. Just do your due diligence and make sure you're not working with any program utilizing under arrangements (not performing work at the hospital), taking specimens too far away from the hospital and keeping the charges realistic.[/QUOTE]
Your name or email address:
Do you already have an account?
No, create an account now.
Yes, my password is:
Forgot your password?
Stay logged in
Cafepharma Message Boards | Pharma Sales, Device Sales, Lab Sales
Home
Forums
>
Laboratory/Diagnostic Sales
>
Laboratory/Diagnostic Sales General Discussion
>
List of Labs with hospital billing schemes
>
Cafepharma Message Boards | Pharma Sales, Device Sales, Lab Sales
Home
Forums
>
Laboratory/Diagnostic Sales
>
Laboratory/Diagnostic Sales General Discussion
>
List of Labs with hospital billing schemes
>