News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Getting Paid for COVID-19 Test Claims: Prepare for Audits, Maximize Reimbursement, and Navigate New Payer Trends


Held Wednesday, May 19 | Available to Stream On-Demand for $195

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Getting reimbursed for clinical laboratory COVID-19 testing is not a given

There are many reasons why clinical laboratories will either not be paid for COVID testing or, more likely, will be paid, but later face post-payment audits that result in the recoupment of some payments. According to our experts, government payer audits of COVID-19 testing claims, as well as commercial payer disputes, will intensify.

Recoupments for COVID-19 test claims that were reimbursed could take a heavy toll on clinical laboratory revenue—hindering growth and ultimately threatening the sustainability of many labs. Add the potential for federal-level punitive actions, and laboratories might have a lot to lose as a result of seizing the opportunities—and generous federal funding—that have come with the COVID-19 public health emergency.

This 90-minute webinar, Getting Paid for COVID-19 Test Claims: Prepare for Audits, Maximize Reimbursement, and Navigate New Payer Trends, will help you and your lab staff gain new knowledge for avoiding medical necessity denials and dealing with payer disputes; optimizing COVID-19 test billing claims and revenue capture; and understanding what actions to take now to navigate the emerging payer trends.

As many clinical laboratory leaders know, a complex maze of federal and state guidelines looms over the clinical lab testing industry. These are especially unfamiliar hazards for those entering the clinical laboratory testing space for the first time.

Many clinical laboratories might be failing to comply with all the rules that are required to retain reimbursement for COVID-19 test claims due to evolving and sometimes inconsistent guidance. For this reason, we have invited top clinical laboratory legal, regulatory, and payer experts to shed light on areas where laboratories may be falling short. All of this COVID-19 testing business intelligence is part of a 3-part webinar, Getting Paid for COVID-19 Test Claims.


Three focused sessions, specific guidance from experts

This exclusive, Dark Daily webinar is divided into three focused sessions—with different subject matter experts covering each topic, as follows:

Session 1: Legal & Regulatory

Caitlin Forsyth, Esq., and Kathryn F. Edgerton, Esq., from Davis Wright Tremaine, provide a valuable update on the medical necessity coverage guidelines for COVID-19 testing. When payers assert that COVID-19 testing is either screening, surveillance testing, or employee return-to-work testing, reimbursement for such testing may be at risk. During Session 1, the Davis Wright Tremaine team will discuss developments in government payer audits and commercial payer disputes, as well as the state of coverage and potential funding sources for pooled/surveillance COVID-19 testing. The information covered in this webinar will help clinical laboratory leaders better negotiate payment for COVID-19 tests upfront in testing services agreements and mitigate the risks of noncoverage when submitting claims to government and commercial payers.

Session 2: Coding & Billing

Improper coding is a long-standing area of clinical laboratory test payment problems. With COVID-19 test claims, Medicare has established separate modifiers that must be well understood to best code and bill for COVID-19 testing. Further, there are new considerations for proprietary laboratory analyses (PLA) and ancillary service coding. Knowing which codes to use and which services can be billed are key to ensuring that your laboratory receives all the payment to which it is entitled. During this Session 2, Diana W. Voorhees, Principal and CEO of DV & Associates Inc., will walk you through the essential information you need to better optimize your laboratory’s COVID-19 claims.

Session 3: Payer Perspectives

There is no question that strategizing clinical laboratory operations for “life after COVID” has begun. However, laboratory leaders are still balancing the needs of pre-pandemic business and ever-present COVID business conditions. Further, regardless of whether the pandemic winds down, it appears that COVID-19 testing is here to stay—but the rules of COVID-19 claims payment and payer policies will change as the public health emergency expires. With clinical laboratory payer relationships beginning to change, lab leaders must ensure they have sufficient “runway” for dealing with emerging payer trends. In the third session of this webinar, Steve Stonecypher, Managing Partner for Shipwright Healthcare Group, will focus on what to know and how to respond to changing payer trends as clinical laboratories transition to business and COVID-19 testing beyond the public health emergency.



Webinar takeaways:

  • Understand the latest COVID-19 medical necessity coverage guidelines of Medicare, Medicaid, and commercial insurers
  • Update your knowledge of coverage for pooled/surveillance testing for COVID-19
  • Learn about potential OIG audits and commercial payer disputes headed our way
  • Hear about novel funding sources for COVID-19 testing, including the HRSA uncompensated care fund and funding by state and local governments, and review the traditional funding sources for diagnostic testing
  • Learn best practices for COVID-19 testing services agreements
  • Get answers to questions that relate to billing for transportation of specimens
  • Receive an update on new codes for billing the administration of vaccines and why this is important for clinical laboratories
  • Learn about PLA (Proprietary Laboratory Analysis) codes and their applicability for COVID-19 testing
  • Gain new knowledge to help solve COVID-19 test claims issues involving diagnosis coding and reporting ICD-10 codes
  • Distinguish payer market trends as they relate to pre-COVID, pandemic, and “life after COVID” conditions, and how market conditions affect billing and reimbursement
  • Learn about potential opportunities with “Minimal Network Admissions”
  • Gain an understanding of new payer processes anticipated as the public health emergency begins winding down and expires
  • Prepare to deal with the new rules of narrow networks

Who should listen?

  • Billing and finance executives
  • Laboratory leadership
  • Compliance officers
  • Billing and coding administrators



Don’t put off gathering these critical insights you need to maximize getting paid for COVID-19 test claims—attend this webinar to inform your lab now. It’s one of the best and most cost-effective investments you can make to be confidently and effectively prepared for the compliance, audit, and managed care challenges coming at you in the months to come.



Expert Presenters

Bruce Quinn, MD, PhD

Caitlin Forsyth, Esq.
Associate Attorney
Davis Wright Tremaine LLP
Seattle, WA

Caitlin Forsyth, Associate Attorney at Davis Wright Tremaine, focuses her practice on the healthcare industry, regularly providing guidance to healthcare providers on a wide spectrum of regulatory matters, including federal and state licensure requirements; state health information privacy laws; Medicare and Medicaid coverage, reimbursement, and compliance; federal and state fraud and abuse laws; and telemedicine. She devotes a significant portion of her practice to working with clinical, molecular, and toxicology laboratories.

Heather Agostinelli

Kathryn F. Edgerton, Esq.
Davis Wright Tremaine LLP
Los Angeles, CA

Kathryn F. Edgerton, Counsel at Davis Wright Tremaine, advises hospitals, physician organizations, long-term and behavioral health providers, telemedicine providers, and other health-related organizations on the complex regulatory issues impacting the healthcare industry. She has a strong focus on compliance issues for addiction treatment and telemedicine providers and is known for her pragmatic guidance on a large range of operational issues. Edgerton regularly advises on HIPAA, HITECH, and state privacy and security laws and regulations.

Rob Metcalf

Diana W. Voorhees
Principal and CEO
DV & Associates Inc.
Salt Lake City, UT

Diana W. Voorhees is Principal and Chief Executive Officer of DV & Associates Inc., a coding, reimbursement, and compliance consulting firm that provides consulting for physicians and facilities related to pathology and laboratory medicine. Prior to that, she was Director of Sales and Marketing and Senior Consultant for a national coding and reimbursement consulting firm. Voorhees initiated her career in laboratory medicine within the Division of Hematology, Department of Medicine at the University of Utah.

Rob Metcalf

Steve Stonecypher
Managing Partner
Shipwright Healthcare Group
Greensboro, NC

Steve Stonecypher is Managing Partner for Shipwright Healthcare Group, a specialty agency delivering strategic expertise in the US commercial payer space for both early-stage, emergent technologies along with more established organizations. Shipwright Healthcare Group develops technology road maps to market evaluation, assessment, and deployment, and provides expertise centered on analyzing, advocating, and enhancing reimbursement for emergent and mature healthcare providers. Shipwright Healthcare Group works closely with clients to tailor national-level payer strategies, as well as regional and state-specific market positioning and contractual administration.