August 2022

Full Focus: How the SALSA Act Would Fix Clinical Lab Repricing

Clinical Laboratory Fee Schedule repricing under PAMA has long been a pain point for labs and the patients they serve. Fortunately, the recently introduced Saving Access to Lab Services (SALSA) Act would fix the currently inequitable process by requiring CMS to use a statistically representative sample of the entire laboratory market to determine future CLFS rates and creating protections against drastic annual rate cuts. Voicing support for SALSA will be key as the act must pass prior to the next scheduled PAMA reporting cycle in January 2023.

Please join us Wednesday, Aug. 31 at noon ET as we welcome Erin Morton, Senior Vice President, and Meghan Riley, Vice President, of Washington, D.C.-based CRD Associates to provide an overview of the SALSA Act and how the legislation would impact the current PAMA reporting process. We will also provide an update on action steps labs can take to support SALSA and set the CLFS on a sustainable path moving forward.
1. How PAMA Has Hurt Clinical Labs and the CLFS

Since it's introduction, PAMA has had a drastic negative impact on Clinical Lab Fee Schedule (CLFS) and opponents of the law have long argued its methodology for setting rates is flawed. In this video, Mick Raich, President of RCM Consulting for Lighthouse Lab Services, offers some revenue cycle strategies lab owners can pursue to help offset some of these ongoing cuts, while also looking ahead to how the SALSA Act could help fix the currently broken data collection process.

2. Take Action: Don't Let CMS Undermine CLIA's Personnel Requirements

CMS recently released a proposed rule that seeks to revise CLIA personnel standards to add nursing degrees to the CLIA high and moderate complexity testing personnel requirements. The proposal would place nursing degrees on the same footing as more appropriate degrees in medical laboratory science, biology, and chemistry. 

While the proposal may be well intentioned, Lighthouse strongly believes high-complexity must be performed by trained medical lab professionals. That's why we're helping to promote the American Society for Clinical Pathology in their efforts to collect signatures for a letter to CMS outlining why this proposal is misguided and undermines CLIA's current personnel requirements.

3. Why Medical Labs Must Focus on Retention and Flexibility

The staffing shortage of medical lab scientists is a nationwide issue that has been plaguing the industry for years. The Great Resignation has made this problem more prevalent, and medical labs across the country have been struggling to fill positions as a result.

To combat this, labs should prioritize retaining the good employees they have, while also implementing flexibility to keep and attract scientists, says Tara Luellen, Lighthouse's Vice President of Lab Director Services, in our latest video.

4. Case Study: Improving Denial Management Through AI

We were recently contacted by an independent pathology practice in Louisiana that offers services including Fine Needle Aspirations, pap smear screening, full surgical pathology, and cytology services, as well as complete clinical laboratory testing. The practice was seeking an RCM solution that would allow them to begin at a 10,000-foot view and identify their largest denials.

Read the case study below to learn how our denial management software, RCM Spotlight, helped the lab identify and get paid on $40,000 of previously denied claims.

Deep Dive: 6 Tips for How to Get In Network With Insurance Companies
Has your lab or group encountered obstacles when trying to determine how to get in network with insurance companies who represent your patient population? If so, you’re not alone. Health insurance companies manage their provider networks in a variety of ways and under different strategies.

Even when a particular network is difficult to enter, there are strategies a lab can pursue to improve their chances of getting in network. The following article outlines several strategies can help your lab distinguish itself and become an invaluable part of any payer’s network.
“When a client identifies a closed network they’d like to enter, we try to drill down and determine what that ‘closed’ status truly means. There are a number of plans you can get into if you present something that’s very unique and a value add to their network.”

-- Brennan Burns, Vice President, Payer Contracting, Lighthouse Lab Services and Burns Consulting Group
1. The NAPA Pain Conference

August 18-21, 2022, in Napa, CA.

2. ASCP Annual Meeting

Sept. 7-9, 2022, Chicago, IL.

3. The Lab Directors Summit

Sept. 12-14, 2022, Austin, TX.
CLIA Lab Director Openings
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The Lab Insighter is a monthly publication for Lab Owners and Decision Makers.