Government and private health insurers increase audits, compliance checks, and claims challenges: Webinar to address key preparations clinical labs and pathology groups should make for next round of payer audits


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Media Contact: Ron Martin


AUSTIN, Texas (February 12, 2015) — Clinical laboratories and pathology groups are reporting greater scrutiny of lab test claims and more audit activity by payers. Increased attention is going into new areas of lab billing and collections, such as out-of-network billing. Another area of heightened investigation by private health insurers and Medicare program officials is that of medical necessity.

“Increased payer audits and analyses of these and similar issues associated with laboratory claims and collections puts every lab organization at risk,” states Robert L. Michel, Editor-in-Chief of The Dark Report.   “This is particularly true if they are caught by surprise when a payer or a Medicare Administrative Contractor wants to audit the lab, or requests documentation to support the medical necessity of selected lab test claims.”

To provide lab administrators and lab coding, billing, and collections professionals with the latest intelligence and timely information about these new payer priorities, a special webinar entitled “Preparing Your Lab for the Next Round of Payer Audits: Emerging Issues with Out-of-Network Billing, Medical Necessity, and Other Payer Concerns” is being presented on Tuesday, February 24, 2015 at 1:00 PM EST. The distinguished faculty of this web conference, Jane Pine Wood and Richard S. Cooper, attorneys from the respected firm McDonald Hopkins in Cleveland, OH, provide professional services to labs in almost every region of the U.S. Together, Wood and Cooper will provide both a national and regional perspective on how different payers are challenging labs on such issues as out-of-network billing, patient balance-billing, medical necessity, and lab-to-physician payments for studies, registries, and similar activities.

“During this webinar, we expect Ms. Wood and Mr. Cooper to also identify and discuss other emerging new issues with laboratory claims and collections,’” continued Michel. “One example is Palmetto’s draft LCD guidance on IHC and special stains—because when implemented, new guidelines will be established that will affect many lab organizations across the nation.”

Among the valuable information to be presented during this 90-minute webinar:

  • What labs should do to prepare for an audit of out-of-network claims
  • Key issues in how labs balance-bill patients and why health insurers now want to enforce contract provisions governing patient billing
  • How labs should respond when a payer sends a letter and wants documentation that the lab is billing patients appropriately
  • Why payers are now motivated to ask labs to document medical necessity for a growing proportion of lab test claims
  • The essential steps every lab should take to prepare for medical necessity audits of lab test claims
  • Understanding why payers are now scrutinizing lab payments to physicians for studies, registries, and the like
  • A discussion of related issues including Palmetto’s draft LCD guidance on IHC and special stains


As an extra value-added benefit of this webinar, the end of the session will be opened up for a live Q&A. For more information about “Preparing Your Lab for the Next Round of Payer Audits: Emerging Issues with Out-of-Network Billing, Medical Necessity, and Other Payer Concerns” and to view webinar details including presenter biographies and pricing, visit You may also contact Ron Martin at 512-264-7103.

Established in 1995, THE DARK REPORT is the leading source of exclusive business intelligence for laboratory CEOs, COOs, CFOs, Pathologists and Senior industry executives. It is widely read by leaders in laboratory medicine and diagnostics. The Dark Report produces the famous Executive War College on Laboratory and Pathology Management every spring, which showcases innovations by the nation’s and globe’s leading laboratory organizations. Dark Daily is an Internet-based e-briefing intelligence service, read worldwide by thought leaders in laboratory and pathology management. Other well-known conferences conducted by THE DARK REPORT are Lab Quality Confab (on the use of Lean and Six Sigma methods in labs and hospitals), Molecular Summit (on the integration of in vivo and in vitro diagnostics). THE DARK REPORT co-produces Frontiers in Laboratory Medicine annually in the United Kingdom; Executive Edge bi-annually in Canada; and The Business of Pathology bi-annually in Australia.