Compliance Gaps Impacting Laboratory Operations and Revenue: Practical Insight and Tips

Track: Regulatory Changes

Session Number: 101
Date: Mon, Apr 1st, 2019
Time: 8:00 AM - 9:00 AM
Room: Ft. Worth 5-7

Description:

The presentation will educate participants on compliance issues that emerged on the national platform and changed policy in 2018-2019, as well as the compliance risks that frequently plague even the most compliant-minded laboratory operators with significant consequences.  The topics will include germane regulatory updates, reimbursement and billing audits, and government enforcement actions.  The focus will be providing actionable knowledge and recommendations of best practices to achieve regulatory compliance and be prepared to demonstrate an effective compliance program that is part of the culture and not just existing on paper.

(Likely) Significant Topics:

  • Medicare/PAMA: Whether any developments in regulation or case law changes whether your laboratory is an “applicable laboratory” required to collect and report payment data to CMS starting January 1, 2019.
  • Waiver of Patient Responsibility: Whether any decisions in pending federal actions between commercial health plans and clinical laboratories may change how providers handle collections of patient cost-sharing obligations.
  • Medical Necessity: Whether any enforcement actions impact how your laboratory must conduct its account setup and test requisition process to avoid recoupments for technical errors or lack of documentation.
  • Pass-Through Billing: Whether any decisions in pending civil actions against hospital reference laboratory billing impact such arrangements and standard reference laboratory billing arrangements.
  • Civil Penalties: How significant enhancements to enforcement powers and penalties under the federal Anti-Kickback Statute and False Claims Act is used by government agencies in investigations and settlements with the laboratory industry.
Session Type: Breakout Session

Body of Knowledge Domains: Compliance and Risk Management
Content Level: Advanced
Learning Objective 1: Describe developments in reimbursement and billing compliance (coding, coverage and payment) to revise protocol and develop business strategies.
Learning Objective 2: Understand marketing and billing practices that catch the attention of government and commercial payors.
Learning Objective 3: Identify what actions are critical to build and implement a compliance program that is acceptable to federal and state government agencies and outline steps to identify and address a compliance issue or billing error (voluntary refund, self-disclosure, etc.).
Session Type: Breakout Session

Body of Knowledge Domains: Compliance and Risk Management
Content Level: Advanced
Learning Objective 1: Describe developments in reimbursement and billing compliance (coding, coverage and payment) to revise protocol and develop business strategies.
Learning Objective 2: Understand marketing and billing practices that catch the attention of government and commercial payors.
Learning Objective 3: Identify what actions are critical to build and implement a compliance program that is acceptable to federal and state government agencies and outline steps to identify and address a compliance issue or billing error (voluntary refund, self-disclosure, etc.).