THE DARK REPORT
21806 Briarcliff Dr.
Spicewood, Texas 78669
FOR IMMEDIATE RELEASE
Media Contact: Ron Martin
AUSTIN, Texas (October 14, 2015) — Quietly and with little fanfare, government and private health plans are taking tougher actions to ensure that clinical labs and pathology groups are complying with laws, regulations, and managed care contract terms. Increasing are both the number of medical laboratories and pathology groups being targeted for audits of lab test claims, and the issues for which they are being audited.
“Payers are unquestionably tightening the audit noose on larger numbers of labs,” says Robert L. Michel, Editor-in-Chief of The Dark Report. “And it’s a simple fact that this steady increase in the number of payer audits is catching many clinical labs both off-guard and unprepared.” Continued Michel, “That lack of preparation has a big consequence: post-audit, these labs often find themselves faced with a large demand for return of overpayments and repayments associated with lab test claims determined to fall outside the payer’s requirements.”
To help labs learn the latest methods to employ, how to mitigate their audit risk, and how they can effectively respond if an audit does occur, The Dark Report has put together an all-new webinar entitled “Update on Government and Private Payer Audits: Prepare Your Lab with the Newest Audit Tactics,” to be presented Wednesday, October 21, 2015 at 1:00 PM EDT. During this webinar, laboratory administrators and lab coding/billing/collections professionals will have the opportunity to engage with two nationally-known experts in managed care contracting, lab regulatory affairs, and payer audits, and get the latest intelligence and timely information about these new payer priorities.
The distinguished faculty of this web conference consists of Jane Pine Wood and Richard S. Cooper, attorneys with McDonald Hopkins of Cleveland, OH. Among the important topics to be addressed by Wood and Cooper are audit activity by CMS and commercial payers, with an enlightening discussion about the increased frequency of audits, the items being focused on, and the tactics being used. Laboratories participating in the webinar can also expect valuable insights on how their labs can mitigate their audit risk, and steps to take to effectively respond to an audit.
Additional points scheduled to be discussed during this 90-minute webinar:
- Why out-of-network billing has become the subject of payer interest and 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 their lab is billing patients appropriately
- Why the OIG’s June 25, 2014, fraud alert about laboratory payments to referring physicians caught the attention of private insurers and is triggering audits involving this type of activity
- Why payers are now motivated to ask labs to document medical necessity for a growing proportion of lab test claims, and steps labs should take to prepare for these types of audits
- Why payers now are scrutinizing lab payments to physicians for studies, registries, and similar activities
- Discussion and review of related issues, including why both the government and private insurers are now looking skeptically at contract lab sales relationships, plus a discussion of toxicology and pharmacogenomics registries as areas of audit focus
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 “Update on Government and Private Payer Audits: Prepare Your Lab with the Newest Audit Tactics” and to view webinar details including presenter biographies and pricing, visit tinyurl.com/AuditUpdate. You may also contact Ron Martin at 512-264-7103.
For additional information, Contact: Ron Martin, 512-264-7103
About THE DARK REPORT
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) and 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.