Why Health Insurers Make It Tougher for Clinical Lab and Pathology Test Claims to Get Paid: Steps to Help Labs with Patient Billing, Out-of-Network Claims, Brutal Audits, and Use of Contract Sales Reps

AUSTIN, Texas–(BUSINESS WIRE)–Getting paid for lab test claims is becoming the #1 issue for the nation’s clinical laboratories and pathology groups. Private health insurers and Medicare contractors are enacting harsh requirements, causing a growing proportion of lab test claims to be rejected. Behind the scenes, both government and private payers are conducting audits of lab test claims resulting in onerous, and often unwarranted, recoupment demands.

These developments hit labs where it hurts most: by cutting their cash flow. Even when claims are resubmitted and eventually paid, many labs struggle to maintain revenue at adequate levels. Help for lab managers and pathologists tasked with managing coding, billing, and collection functions of their lab organization comes by way of this timely webinar, “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.“ The webinar, hosted by Pathology Webinars, LLC, will take place Wednesday, December 6, 2017 at 2:00 PM EST.

Three esteemed experts will provide the inside scoop on the best actions clinical labs and pathology groups can take to manage these major changes and unwelcome developments: Rina Wolf, VP, Commercialization Strategies, Consulting & Industry Affairs, XiFin; Karen Lovitch, Practice Leader, Health Law Practice, Mintz Levin, PC; and moderator Richard Faherty, CEO of RLF Consulting, formerly with Bio-Reference Laboratories.

One urgent topic involves prior authorization of molecular and genetic tests. In recent months, two major insurers instituted prior-authorization requirements for their collective 80 million beneficiaries. Because of these recent prior-authorization changes, many labs find it exceedingly difficult to work with their client physicians to obtain the necessary prior authorizations required to be paid. Webinar participants will get the perspectives of both an experienced attorney and an executive at one of the nation’s largest lab billing/collections companies, to learn what is working for their clients, and key steps labs and client physicians should be taking to obtain more prior authorizations with less time and effort.

Another major source of concern for 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. When medical justification, documentation, or due diligence is deficient during lab test claim audits, payers are seeking recoupment. Because prevention is a key factor, the right way to document lab test claims, implement a robust compliance programs, and demonstrate that a program is being strictly enforced in order to avoid potential issues will all be addressed.

As particular attention is now being paid by payers of all kinds to patient billing compliance issues, participants will hear what their lab needs to do to avoid adverse consequences in these areas. Finally, regarding the trend of contract (or third-party) sales and marketing representatives who sell lab and pathology services, kickback statutes now applicable in this area will be discussed, and why attention to the sales activities of both in-house and contract sales reps is crucial.

For more information about this webinar and to view details including presenter biographies and pricing, click here.

Contacts

• Pathology Webinars, LLC
• Chris Garcia
• chris@pathologywebinars.com