Program 2018-05-23T13:16:31+00:00

Program subject to change. Please check back for updates.

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
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
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
Presenter: Mick Raich, President/CEO Vachette Pathology and Stark Medical Auditing

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.

Presenter: Greg Richard, Chief Commercial Officer, Interpace Diagnostics

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.

Presenter: Richa Singh, EVP, Collect Rx

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.

Join us to learn the answers to frequently asked questions about the out-of-network landscape, such as:

  • How to negotiate and appeal out-of-network bills more successfully
  • The varying out-of-network policies
  • Understanding the factors of how out-of-network bills are paid
  • Third-party network agreements