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Anyone responsible for laboratory billing knows that the process is complicated and fraught with legal and regulatory landmines. Regulations are constantly changing and being updated, with different standards in place for government and commercial payers. To be successful, laboratory managers not only must be familiar with the rules of today, but they must also be mindful of the rules that were in place last week and those that will be put into effect tomorrow. It requires daily interaction with payers of all shapes and sizes and the handling of thousands of daily claims. The Best Practices in Laboratory Billing and Coding series will help you navigate this complicated topic.

Module 1: Do It Right Upfront -
Submitting Claims for Laboratory Services
Wednesday, September 12, 2007 | 3-4:30 p.m. ET

This module will cover current business and regulatory issues affecting laboratory claims submission processes for government payers, such as Medicare and Medicaid, and other payers, such as third-party insurance and private payers. Many things affect a laboratory’s ability to submit timely and clean claims that meet state and federal requirements. With the emphasis on false claims act violations at both the state and federal level, the chances of an error becoming a big problem for a laboratory have increased. Find out about the best tools and processes to employ to get paid as quickly as possible and stay out of trouble with the government. Bring your questions and get answers during the Q&A part of the program.

Participants will:
• Understand the requirements for a clean and compliant clinical
   laboratory claim
• Obtain tips and suggestions for dealing with ordering entities to get
   the information needed to meet claim requirements
• Understand differences and similarities between submitting claims
   to commercial and government payers.

Module 2: If at First You Don’t Succeed! - Dealing with Denied Claims
Wednesday, October 24, 2007 | 3-4:30 p.m. ET

Your mother always said that “no” means “try again” (except when she was the one saying it). The same goes for claims denials. “No” means “take a second look at the claim and figure out why it didn’t get paid.” If it is your problem, fix the claim and resubmit it. If the denial seems wrong or inappropriate, challenge it through the appeals or grievance process for the denying payer. In order to do so, you must understand those processes. Interpreting denial messages on RAs is an art and skill that is essential to successful billing. This session will explain how resubmission, reconsideration, and appeals processes work for government payers such as Medicare and Medicaid and what options you may have for commercial payers. It will also help you understand which denials may have important compliance implications.

Participants will:
• Understand how to avoid problems caused by their own billing systems
   errors or edits
• Learn how to interpret the information provided with claim payments
   or denials to better understand how to handle them
• Get tips about trending and tracking denials to help detect bigger problems
   in their systems and avoid problems with the government

Presenter: Christopher P. Young is certified in HealthCare Compliance (CHC) by the Health Care Compliance Board of the Health Care Compliance Association. He is a compliance professional with nearly 20 years of
experience in laboratory compliance issues. He is an HEW-certified medical technologist, former chairperson of the CLMA Health-Care Policy Committee (HCPC), and former member of the Medicare Billing Issues Committee (MBIC) for CLMA. He is currently serving as the laboratory representative on the Carrier Advisory Committee for Arizona. Mr. Young has worked directly with government representatives in the shaping of laboratory legislation. He has contributed articles to Vantage Point, Laboratory Industry Report, and other health-care publications; he is a member of the Board of Advisors for Laboratory Compliance Insider and writes a regular bimonthly column for the Journal of Health Care Compliance. He speaks locally and nationally on health-care compliance, regulatory issues, Medicare and Medicaid billing and other laboratory-specific topics. During nearly 40 years as a laboratory professional, Mr. Young has had the opportunity to work in or with every kind of laboratory setting. Mr. Young is currently working as an independent consultant specializing in regulatory matters and the development of compliance officers and programs for clinical laboratories.

Module 3: 2008 Coding and Reimbursement Update
Thursday, December 6, 2007 | 3-4:30 p.m. ET

The 2008 Coding and Reimbursement Update will discuss the new 2008 CPT codes, medically unlikely edits (MUEs) and how they may affect reimbursement, compliant billing of molecular diagnostic laboratory services and surgical pathology intraoperative consultations, plus other 2008 laboratory billing issues.

Attendees will learn:
• New and revised 2008 AMA CPT codes
• How to handle medically unlikely edits (MUEs)
• Challenges of compliant coding in molecular and pathology services
• Other 2008 laboratory billing issues

Presenter: Joan Logue is a principal with Health Systems Concepts, Inc. (HSC), a leading national consulting firm for clinical laboratory Medicare coding and billing compliance and Medicare regulations. She is also a
principal with Health Software Consulting, a software company providing compliance audit software for clinical laboratory claims. Joan has extensive laboratory consulting experience and is nationally recognized as an expert on Medicare laboratory billing regulations and reimbursement issues. HSC clients include hospital and national reference laboratory clients throughout the country and manufacturers and distributors of clinical laboratory in vitro diagnostic products.

Format: Three 90-minute web conferences

Pricing:
All 3 Modules:   Member $599   Nonmember $899
Single Module:  Member $249   Nonmember $399

*Pricing is per phone line with an unlimited number of participants and also includes a CD recording of the program. CDs are mailed approximately 10 days after each program.

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