This webinar will give you the right strategies to save your lab thousands in penalties, compliance costs, and other revenue hits, and sets you on the right path to a profitable 2018!
Government and private health plans are taking a hard line in 2018 to ensure that pathology groups and clinical labs are complying with new laws and regulations, and managed care contract terms. The new year will bring significant changes to patient billing practices, out-of-network claims, lab audit initiatives, and lab sales protocols. These challenges all boil down to one thing: tougher actions by government and private payers which add up to negative financial consequences for the nation’s pathology groups.
When you register to attend “How to Prepare Your Lab for 2018: Essential Insights into New Payer Challenges with Lab Audits, Patient Billing, Out-of-Network Claims, and Heightened Scrutiny of Lab Sales Practices” on Wednesday, December 6, 2017, three esteemed experts in the field will provide you with the inside scoop on the best responses and actions your pathology group can take to these major changes and unwelcome developments.
PAMA is the most discussed subject among pathology practices and experts. With clarity on this issue imminent, you’ll hear the very latest on the publication of the final Part B CLFS, and how your laboratory should prepare to deal with this challenging new fee schedule.
More and more demands for prior authorizations by payers in the area of molecular diagnostics is the next topic of discussion. You’ll hear about what is happening with other laboratories’ genetic test orders, the types of genetic tests that are being affected, details on how payers are implementing their prior-authorization programs, and—most importantly—the steps your lab can take now to effectively deal with these prior-authorization requirements.
Another major source of concern for many pathology groups is the more frequent and intense audit process by government and commercial payers. A growing number of health insurers are initiating audits to review prior paid services, particularly to audit for proof of medical necessity. During the audit, when the medical justification, documentation, or due diligence is missing or deficient for lab test claims, payers are seeking recoupment in the form of clawbacks or refund checks. Because prevention is a key factor, you’ll learn the right way to document your lab test claims, implement a robust compliance programs, and be able to demonstrate that your program is being strictly enforced in order to avoid potential issues.
Next, as particular attention is now being paid by payers of all kinds to patient billing compliance issues, with increased scrutiny on every aspect of patient billing compliance—ranging from medical necessity issues, to improper rules regarding co-pays and deductibles, to custom profiles that can result in over-testing—you’ll hear what your lab needs to do to avoid adverse consequences in these areas.
And there’s more. Get the latest about the increased focus now being placed on sales and marketing practices of lab representatives, and why your lab needs to ensure that it has clear oversight of its sales representatives and programs, which includes an enforceable compliance plan. This topic is equally, if not more, important if you have turned over your program to an outside consultant or selling group (who may or may not employ best practices). Because kickback statutes are applicable in this area, your attention to the sales activities of both employed sales reps and contract sales reps is crucial. Actual examples of violations that have occurred will be covered, giving you critical insights into which of your compliance areas may need to be addressed.
This is an essential session for pathologists, pathology practice administrators, and billing managers alike, and will afford you the opportunity to interact directly with our experts and gain the benefit of their invaluable perspectives and recommendations. For one low price—just $195 (through 11/28/17; $245 thereafter)—you and your entire team at one location can take part in this insightful webinar. Best of all, you’ll be able to connect personally with our speakers when we open dialogue for questions from the audience.
New, even tougher challenges are coming to all pathology labs in 2018. Learn essential strategies your team needs to implement now, to keep your lab group strong and thriving!
Rina Wolf is a nationally recognized expert in the field of laboratory commercialization and reimbursement, with over 20 years of experience in the diagnostic laboratory industry, specializing in Molecular Diagnostic Laboratories. Wolf lectures extensively on these topics and has consulted for over 50 laboratories in the areas of commercialization, optimizing reimbursement and coverage, and compliance. She is an active participant and advocate in industry affairs, a member of relevant AMA workgroups, a former President and board member of the California Clinical Laboratory Association and an active participant with the ACLA, AMA and the Personalized Medicine Coalition. Rina also advises and presents to investor audiences, with recent speaking engagements that include William Blair, UBS, Piper Jaffray, Cowen Group, Macquarie and Bloomberg’s G2 Intelligence Lab Investment Forum. She is also on the faculty of ASU International School of Diagnostics. Prior to joining XIFIN, Rina was responsible for creating and implementing successful reimbursement strategies with executive positions in the area of commercialization and reimbursement at RedPath Integrated Pathology, Genomic Health, and Esoterix (now LabCorp).
Karen Lovitch counsels health care clients on regulatory, transactional, and operational issues, including Medicare coverage and reimbursement, the development and implementation of health care compliance programs, and licensure and certification matters. In addition, Lovitch advises clients on the legal, practical, and fraud and abuse implications of business arrangements and sales and marketing practices. Her experience includes matters related to the anti-kickback statute, the Stark law, state statutes prohibiting kickbacks and self-referrals, and the federal Physician Payments Sunshine Act.
Karen applies her compliance and regulatory experience in transactional as well as litigation contexts. In addition to counseling health care entities on regulatory matters arising in connection with mergers and acquisitions, she has successfully defended clients subject to state and federal surveys, Medicare and Medicaid overpayment and reimbursement appeals, and state licensure proceedings. She also specializes in the representation of laboratories and diagnostics companies, regularly counseling on compliance with CLIA and state laboratory licensure laws, federal and state limitations on billing for diagnostic services, and legal restrictions on sales and marketing activities.
Richard Faherty – Moderator is currently consulting primarily with laboratory services. He was the Executive Vice President, Administration, for BioReference Laboratories, Inc. (BRLI) until his retirement in July 2017. Faherty spent more than 20 years at BRLI overseeing general corporate affairs as well as all technology; he was President of PSIMedica (the Company’s clinical knowledge management division) and the creator of CareEvolve, the Company’s connectivity solution up until its recent sale to ELLKAY. Prior to BRLI, Mr. Faherty worked in financial technology at S&P Comstock and A-T Financial Services, Inc. as well as a Y2K project manager for MetLife. At both S&P Comstock and A-T Financial, Mr. Faherty managed the support, maintenance and deployment of real-time data products utilized by traders, brokers, analysts and financial executives who require complex, high-speed data solutions delivered to their desktops over private and public networks. Mr. Faherty has been associated with the clinical laboratory business since 1986 when he began consulting for GenCare Biomedical (later acquired by BioReference) and he has been involved in the industry since that time.
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