28th Annual Executive War College

In this session, Mr. Ross and Ms. Agostinelli explored winning physician engagement strategies and techniques designed to increase ordering volumes, maximize clean claims, and automate denials and appeals management to maximize reimbursement. They discussed novel ways to engage genetic counselors to better anticipate and respond to payor behavior and will report on one such program that leverages genetic counselor knowledge to have greater confidence and predictability of reimbursement success at a payor/plan and test level. They also discussed the most effective patient communication touchpoints and technology enablers to assist patients in preparing for out-of-pocket expenses and increase test completion rates.

As the healthcare landscape evolves, laboratories are seeking new ways to increase revenue, maximize reimbursement, and provide a seamless patient experience. One promising avenue for achieving these goals is through partnerships with pharmacies and specialty physician groups.

In this speaker session, our expert shared valuable insights on this growing trend, emphasizing the value of collaborating with pharmacies to achieve these goals. The speaker discussed the recommended practices for laboratories to partner with pharmacies using collaborative practice agreements, which allow pharmacists to perform clinical tests and prescribe medications based on laboratory results.

This moderator-led panel discussion focused on the role of RCM data and analytics in transforming laboratory business and operational strategies. The talk covered how various stakeholders can use RCM data and analytics insights, including finance executives, revenue cycle leaders, commercialization efforts, and managed care professionals. Key topics for discussion included:

• How analytics help to make informed decisions about resource allocation, investment strategies, and overall financial management
• Identifying inefficiencies and cost-reduction opportunities
• The most common areas of revenue leakage and the best corrective actions to improve billing accuracy and optimize reimbursement rates
• Leveraging RCM data and analytics to gain valuable insights into client health, such as clients at risk of churn or low utilization
• Developing targeted retention strategies based on utilization data and payment patterns

Molecular diagnostics leaders face persistent and unique challenges in growing their laboratory’s market share; several important dynamics can play crucial roles in overcoming these challenges, including accurate code assignment, understanding payor medical policies and prior authorization requirements, and maximizing efficient claims reimbursement with an effective appeals strategy. This session provided a comprehensive overview of data-driven best practices in genetic test coding, billing, and collections, as well as insights into the prior-authorization process.

The speaker session was designed to provide attendees with an in-depth understanding of the complexities surrounding billing issues related to genetic testing and whole genome sequencing services.

The session focused on the challenges providers face when submitting claims for these services, particularly when they are performed at different locations. Attendees learned about the specific billing requirements that must be met in order to receive reimbursement, as well as strategies for overcoming common billing issues and denials.