NGS Oncology Panel Reimbursement:
What does the future hold now that CMS has issued an NCD?
Presenter: Chance Scott, Associate Director, Life Sciences | Navigant
In March 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final National Coverage Determination (NCD) for patients who receive next generation sequencing (NGS) testing with an assay that meets coverage criteria for solid tumor patients with Stage III and Stage IV, metastatic, recurrent, relapsed, or refractory cancers.
This is a major milestone in payer acceptance for NGS oncology panels.
But what will be the effect on other payers? Will others follow suit? Will they have more or less restrictive coverage indications? And how fast will they act?
This presentation will examine the various positions that different payers have taken on NGS oncology panels in 2018, and highlight the rationale behind their existing polices.
We will also review case studies examining historical patterns of coverage for other high profile, clinically impactful technologies that have gone through the CMS NCD process.
What can history tell us about the future?
After this session, attendees able to:
- translate key implications of the recent CMS NCD for Next Gen. Sequencing
- apply historical benchmarks to under the likely impact on commercial payers
- distinguish nuances across payer segments when evaluating new technologies
Laboratory Compliance 2.0
Presenter: Barb Senters, CCEP, Chief Compliance & Ethics Officer
for Sonic Healthcare USA
This session will provide an overview of how to strengthen the effectiveness of your compliance program to prevent whistleblowers, protect your culture, and utilize compliance as a strategic advantage. It will utilize the speaker’s experience of being a panel member for the OIG’s Resource Guide “Measuring Compliance Program Effectiveness” and her interviewing her company’s former whistleblower.
- Provide tools to ensure appropriate laboratory risks are being addressed
- Explain how demonstrating effectiveness can prevent a federal investigation and/or Corporate Integrity Agreement
- How to use culture to execute the mission of the company, while strengthening the compliance program
Laboratory Operational and Clinical Analytics: Use and Benefits
Presenter: Dennis Winsten, MS, FHIMSS, FCLMA, President, Dennis Winsten
& Associstes, Inc. Healthcare Systems Consultants
Medical laboratories and pathology groups face enormous levels of change in their clinical, regulatory and financial environments. With reduced reimbursement, laboratories are under increasing pressure to optimize business practices, improve utilization and cut costs while improving patient care. To meet this challenge, pathologists and lab managers know they must get better at using metrics to support the many operational decisions required to boost productivity while simultaneously reducing overall costs throughout their labs. Timely access to accurate performance metrics is the single biggest requirement for labs wanting to improve both operational and financial performance while concurrently contributing to enhanced patient care.
This presentation will describe the latest achievements and best practices for both operational and clinical analytics and describe how pathologists can evaluate, select and use analytical software for:
- Retrospective and Prospective Performance Measures
- Utilization Measurement and Monitoring
- Quality Improvement
- Service Level Benchmarking
Auditing Your Lab Revenue, Finding Out What You Are Missing
Presenter: Mick Raich, President/CEO Vachette Pathology and Stark
The billing for lab services is amazing complex and nuanced, there are thousands of variables which go into the process to get paid for services. It is imperative in these times of financial crisis that labs work to audit their billing process. Mick Raich will discuss how this process is handled and teach the attendees the tenets of this process.
- Charge capture, are you billing everything you do?
- Claim review, HFCA versus service performed, are you missing anything?
- Denial management, a primer on how to use denials to increase your revenue.
- Getting paid correctly, comparing your EOB to the actual paid amount. Finding those lost dollars.
This one hour speech will teach those in the lab revenue cycle world how to begin the audit process and where to look for lost revenue.
Out-of-Network: Frequently Asked Questions
Presenter: Richa Singh, Executive Vice President, CollectRX
Out-of-network reimbursements remain a viable option for labs, but many struggle because they are unfamiliar with some of the intricacies required to successfully run an operation with this payment model. In fact, there are many unanswered questions that could greatly affect being aptly compensated for services they are rightfully delivering.
After attending this session, attendees will be able to:
- Negotiate and appeal out-of-network bills more successfully
- Navigate against varying out-of-network policies
- Recognize pitfalls in third-party network agreements
Health System Laboratory Evolution: Achieving Patient Integration
Presenter: Jane Hermansen
With the formation of larger health systems and integrated delivery networks across the US, the role of the laboratory and integrated laboratory data remains of critical importance. What is the best way to achieve balance in local delivery of care and optimization of testing across multiple laboratories? What is most important? Delivering high quality and excellent service? Eliminating redundancy and realizing economies of scale? Can these philosophies co-exist? Patient-centered testing must remain our industry’s top priority. Further, laboratory data integrated with the patient medical record will be critical to the laboratory’s future success in alternate payment models. In this session, attendees will learn of the importance of achieving patient integration across a health system, and how to most effectively accomplish that integration.
- Describe national trends of health system integration and identify the key role of the laboratory in achieving this integration
- Define a laboratory integration strategy, to include internalization of testing, provider use of the health system laboratory and the power and value of integrated patient data
- Develop a plan for integration of laboratory services across a health system which includes a strong outreach program
How to Secure Coverage and Reimbursement for New Technologies
Presenter: Greg Richard
The bar for providing evidence to secure coverage and reimbursement for new technologies is routinely being raised. As an example, laboratories can meet the evidence requirements of Evidence Street and still not meet those of Anthem BCBS, another BCBS Association member. The varying definitions of clinical utility among health plans and third party technology assessment providers require lab companies to conduct numerous studies and publish data in multiple peer reviewed publications with little to no assurance that they will successfully secure coverage. Further, this lack of coverage often results in challenges with physician adoption due to the financial burden placed on patients in the absence of coverage for high cost, molecular testing and the continuing increase in patients’ responsibilities associated with benefit plan design. This talk will provide suggestions to address these challenges for participating laboratory providers.
- Learner will be able to negotiate with Medicare and/or Commercial payers for coverage of molecular products/testing services
- Learner will be able to develop a dossier and effective submission to third party technology assessment organizations
- Learner will be able to respond to RFP’s or other requests for information required to secure coverage
Accelerating Diagnosis and Treatment of Cancer Using Digital Pathology
Presenter: Lisa Jean Clifford, COO & Chief Strategy Officer, Gestalt Diagnostics
This presentation will discuss accelerating the diagnosis and treatment of cancer using digital pathology to improve efficiencies in workflow secondary consults, tumor boards, research, training, and much more.
After attending this session, participants will:
- have a clear understanding of how digital pathology speeds the diagnosis and treatment process for patients
- be able to determine if digital pathology is a good technology for their lab to consider
- know the key areas that digital pathology can help in advancing the pathology workflow process
Medicare Access and CHIP Reauthorization Act (2015) MACRA: What Is It and Why Is It Important?
Presenter: Patricia Goede, Vice President, Clinical Informatics, XIFIN, Inc.
MACRA impacts pathologists’ reimbursement under Part B Medicare reimbursement. The 2018 updates to the legislation introduces changes to the existing mandate that will further impact reporting and financial adjustments. Pathologists need to understand what MACRA is and how it affects their institutions.
This session will be presented in the following parts:
- Historical overview
- MACRA as the mandate
- Financial implications; and
Learning objectives include:
- Introduction to MACRA
2018 MACRA – Quality Payment Program (QPP)
2018 MACRA – Eligibility, Reporting, and Timelines
- Why does MACRA matter to diagnostic providers and how to diagnostic companies benefit from MACRA?
- Data and system requirements for diagnostic companies to increase thir value to providers under MACRA
- Provider Education and Outreach
The Impact of Mindset on the Improvement of the Patient Care Experience
Presenter: Joseph G. Keary, MS, MBA, CEO, JGK Leadership Consulting and Director, Clinical Laboratory Management Association
The essential role of the laboratory profession in providing quality patient care has traditionally been absent from the perspective of our patients and, oftentimes, the medical and nursing staff. The traditional “profile” of the laboratory professional is of an introvert who likes to work away from the limelight and frequently only leaves the bench or office for lunch and to go home. This lack of visibility and lack of clarity on the critical nature of our profession in patient care leads to reduced morale and staff engagement, a lack of respect for our efforts, an increase in the commoditization of lab services ad reduced interest in the profession. We need to break out of our self-imposed cocoon and follow the examples of pharmacists, dieticians, etc., and be active participants in the patient care experience. We also need to become ore engaged in organizational governance and demonstrate the personal and professional value we provide.
After attending this session, attendees will be able to:
- Identify the key differences between outward and inward mindset
- Assess the impact of adopting an outward mindset on a relationship between the Laboratory and the Emergency Department
- Operationalize the tools of the outward mindset in improving both interdepartmental relationships and the patient care experience at their institution
Manage Costs and Eliminate Unnecessary Expenses Using Precise Cost-per-Test Studies
Presenter: Stephen Stone, BBA, Managing Director, Argent Global Services
Learn how laboratory workflow experts execute precise cost-per-test studies as a necessary step in managing costs and eliminating unnecessary expenses. This presentation will explore the correct approach to identifying relevant cost parameters, along with proven ways to analyze the resulting data to intelligently guide cost-cutting efforts.
Attending this session, participants will:
- gain insight on how workflow experts evaluate laboratory costs
- learn the correct approach to identifying relevant cost parameters
- learn how cost-per-test analysis can guide lab improvement efforts
Toxicology and Genetic Testing Audits and Defences
Presenter: Andrew Wachler, Owner/Principle, Wachler & Associates, PC
This presentation will address regulatory, reimbursement, and other legal challenges that confront laboratories that engage in genetic and toxicology testing.
We will also look at audit strategies that address issues of medical necessity and coverage determinations raised by payor such as Medicare, and review new appellate reforms, including Settlement Conference Facilitation and the Statistical Sampling Initiative.
After attending this session, the attendees will be able to:
- Identify and defend against highly targeted audit issues affecting laboratories, including genetic, pharmacogenomic, and toxicology testing;
- Utilize the most current settlement initiatives for the Medicare program. Specifically, the presentation will discuss the settlement initiatives released by the Office of Medicare Hearings and Appeals, including the recently implemented expanded Settlement Conference Facilitation program and the Statistical Sampling Program, which are intended to offer providers an alternative route to reach a financial determination for claims pending at the Administrative Law Judge hearing level without enduring the 2-3 year delay for a hearing; and
- Develop compliance strategies to reduce audit risk.