Volume XXIV
April 2022

Full Focus: New MolDX LCD Impacting Reimbursement for Infectious Disease Testing

Laboratories performing infectious disease (ID) testing and billing Medicare Part B within a MolDX jurisdiction are subject to a new Local Coverage Determination (LCD) that stands to significantly impact reimbursement for these services.

As of April 17th, 2022, this LCD requires all labs in affected MACs (Noridian, Palmetto, CGS, WPS) to register for a unique DEX Z-Code identifier through the Diagnostic Exchange in order to continue receiving reimbursement for "expanded" panels that test for more than five targets. Most ID panels, including RPP and GI expanded panels, will be impacted.

In the video update below, Ann Lambrix, Vice President of RCM Consulting for Lighthouse Lab Services and Vachette, outlines the ramifications of this new LCD and outlines the three crucial steps labs operating within MolDX states need to take to begin this process.
1. The Post-Pandemic Medical Laboratory: What Have We Learned?

As the COVID-19 pandemic turns into an endemic, medical laboratories are looking at issues regarding the staffing shortages of medical laboratory scientists across the country, while also applying what they've learned during the height of the pandemic.

In this video, Jon Harol, President of Lighthouse Lab Services, goes over these topics and more as he discusses the present state of the medical laboratory industry.

Interested in catching more of our video updates? Subscribe to our YouTube channel for new content each month!
2. On Demand Webinar: Adjusting to Changes for COVID Test Reimbursement

Despite the recent decision from HHS and the Biden Administration to extend the COVID Public Health Emergency (PHE) an additional 90 days, policymakers have indicated this is likely to be the final extension of the emergency declaration. With labs preparing to transition away from the waivers and payment flexibilities granted under the PHE, we recently examined hurdles they may face as business begins to more closely resemble the old status quo.

In this April 13 webinar, we review reimbursement changes that are looming alongside the scheduled end of the PHE and offer practical tips to strengthen your revenue cycle management as COVID test volume declines.

3. DCLS Graduate Aims to Increase Medical Laboratory Visibility

Talk to most medical laboratory professionals about their involvement in the patient care process, and you’re likely to hear them describe the need to increase the visibility of the vital role they play.

For Dr. Melissa Bell, DCLS, MS, BS, MLS (ASCP)cm, that desire to move from behind the scenes to more of a bedside patient consulting role is what led her to pursue her Doctorate of Clinical Laboratory Sciences (DCLS) at the University of Texas Medical Branch at Galveston (UTMB) after working in the industry for 15 years, going from a med tech to laboratory director during that time.

Deep Dive: What is MolDX and When Do I Need a Z-Code?
The Molecular Diagnostic Services (MolDX) Program was developed by Palmetto GBA in 2011 to identify and establish coverage reimbursement for molecular diagnostic tests. This program currently provides uniform policies for 28 states, across four MACs.

Effective April 17, infectious disease panels performed and billed in MolDX jurisdictions are subject to a new local coverage determination (LCD) that will require them to register for a unique Diagnostic Exchange (DEX) Z-Code in order to continue receiving reimbursement for these tests. While it may require a fair amount of front-end work, there are several benefits to receiving MolDX Z-Codes.
Receiving a fixed rate for your tests allows labs to create a consistent pricing model, even if reimbursement in some instances is lower. This will also reduce denials, similar to a preauthorization process. In short, your staff or billing team will face fewer hurdles to get reimbursed for your services.

-- Tami Shaw, Client Manager, Lighthouse Lab Services
The following article examines:

  • The history and purpose of the MolDX program.
  • How to register to obtain DEX Z-Codes in order to continue receiving reimbursement for impacted tests.
  • The impact of the new LCD for infectious disease testing.

1. Executive War College

April 27-28, 2022, in New Orleans, LA.

2. Urgent Care Association Annual Convention

April 30-May 4, 2022, in Las Vegas, NV.
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The Lab Insighter is a monthly publication for Lab Owners and Decision Makers.