Program subject to change. Please check back for updates.
Sponsored by LCM Lab Consulting
by Michael Sherman
Speaker: Kyle Fetter
Economic and regulatory pressures are impacting revenue cycle management (RCM), reimbursement, and financial viability for many outreach labs. And, if the draft 2018 PAMA reimbursement rates are implemented in January, many laboratories, including hospital outreach labs, will face severe consequences. In this session, Kyle Fetter will discuss the possible substantial impact these cuts will have on your lab’s operating margins and why it’s important to focus not on cost-cutting, but rather increasing profitability through maximizing reimbursements.
Speaker: Diana Voorhees:
The laboratory community and healthcare, in general, is laden with regulations, laws, guidelines, rules, etc. Identifying and addressing regulations that impact your workplace, implementing and monitoring policies, educating and training employees, performing internal audits, and communicating with all levels of administration demands more than a full-time commitment. This session will highlight a few issues and concerns that have garnered our interest as well as that of the federal and local governments.
Upon completion of the session, participants will be able to:
- List regulations that impact business services and related compliance concerns.
- Highlight and discuss select regulation requirements and appropriate laboratory response.
- Describe outcomes for government interest in regulatory compliance.
Speaker: Jeff Myers
Newly enacted PAMA rates are merely days ahead. What’s the latest, and more importantly, how should hospitals respond? Should hospitals sell their laboratory outreach program? Expand and look to grow volume to offset future losses? This session will cover current and future legislative rates, how to develop tools to understand and monitor the financial impact, and provide a roadmap to offset the impact of pending reductions for the next three years.
Participants of this session will:
- Learn the latest news on PAMA and legal and lobbying efforts regarding the legislation.
- Understand why the hospital CFO might not be concerned.
- Discover how these reductions may help your laboratory’s long-term strategy.
- Understand the impact to hospital outreach programs and their sustainability in future.
Speaker: Ellen Neiduski
The impact of the 2018 CLFS will be felt by every laboratory, and depends not only on the test mix, but the payer mix as well. In this session, we will outline a methodology to help you quantify the impact on your laboratory’s bottom line.
In order to replicate the analysis for your lab, participants will need to understand the following:
- 2017 test volume data by cpt code
- 2017 and/or projected 2018 payer mix
- Current 2017 and projected 2018 fee schedules for their top payers
After attending this session, the learner will be able to:
- Create a sustainable model to aid in estimating laboratory revenues
- Calculate expected Medicare revenues using the 2018 CLFS
- Quantify the revenue impact of 2018 vs. 2017 at the test code level
Speaker: Drew Wachler:
Over the last five years, we have seen a significant increase in toxicology and genetic testing as well as Medicare and third party payor audits of these tests. It is important for those in the industry to know how to protect your laboratory from these audits and collateral consequences. The audience will learn:
- Proactive steps that laboratories can take to reduce audit exposure;
- How CMS applies medical necessity requirement to laboratories;
- The documentation that CMS requires to successfully defend a laboratory audit;
- Important information about the appeals process available to laboratories and new Office of Medicare Hearings and Appeals (“OMHA”) reforms that allow laboratories to settle cases; and
- The defenses of waiver of liability and provider without fault which are particularly applicable to laboratories.
Speaker: Jeff Myers
Hospital outpatient laboratory payment rates are at a point of inflection. For more than the past two decades, hospitals have enjoyed favorable reimbursement on outreach and outpatient laboratory services through utilization of the hospital charge master and leveraging existing hospital-based outpatient contracts. With pending legislative payment reductions in lab upon us, private payers are increasing their efforts to steer patients away from hospital-based outreach and outpatient labs through aggressive marketing to consumers, physicians, and employers. With out-of-pocket costs for consumers at unprecedented levels, hospitals with outreach and outpatient programs that are above market pricing face significant barriers to maintaining and growing their laboratory business service line. The session will focus on what the future holds for managed care reimbursement of laboratory services and the outlook for hospital outreach programs that both charge the patient and are paid more by private payers than current market rates.
Participants of this session will:
- Learn the history of hospital laboratory outpatient/outreach reimbursement.
- Understand the patient disincentive when using hospital based laboratories.
- Discover how price transparency is being used by commercial laboratories and private payers to drive market share loss in the hospital outpatient setting.
- Discover how to use the loss of premium reimbursement for outpatient laboratories to your advantage.
Panelists: Jeff Myers, Ellen Neiduski, and Drew Wachler
Panelists will address how your lab can survive the coming threats to revenue. Recapping their earlier comments, panelists will discuss strategies to survive and possibly thrive in the new environment.