Volume XXIII
February 2022 - Top Stories:

1. Full Focus: Complying with New Surprise Billing Rules

Has your lab or pathology group made steps to bring your billing into compliance with new federal surprise billing regulations that went into effect Jan. 1, 2022? While the No Surprises Act is well intentioned, it has also left labs who have little patient interaction with a number of questions concerning patient notice requirements, how it interacts with existing state laws, and exactly how independent labs vs. hospital-based groups will be impacted.

During this Feb. 23 webinar, we will welcome Danielle H. Tangorre, Partner with Robinson + Cole, and Ann Lambrix, Vice President of RCM Consulting for Lighthouse Lab Services, to discuss these issues and share some early roadblocks created by the law's implementation.
1. Has Your Lab Paused Offering Your COVID LDT Due to the FDA Regulatory Change?

We recently asked 65 lab decision makers this question, and more than half of the respondents stated that they were awaiting further guidance due to the recent policy shift by the FDA to require Emergency Use Authorization (EUA) for COVID LDTs.

If your lab is part of the group awaiting further guidance, Lighthouse's CovidNow RT-PCR assay has received EUA and can serve as an alternative offering to allow your lab to continue to provide this crucial service.

2. What Can Be Reimbursed Through the HRSA Uninsured Program?

Although labs have great coverage options like the Health Resources and Services Administration (HRSA) Uninsured Program, which enables providers to get reimbursement for COVID-19 testing for patients who have no insurance, that coverage is unfortunately not extended to large respiratory panels. However, there are services that may be reimbursed through this route beyond straight COVID testing.

3. COVID-19 Public Health Emergency Receives 90-Day Extension

The COVID-19 Public Health Emergency (PHE) has been extended for an additional 90 days after HHS Secretary Xavier Becerra signed off on the extension last month. This latest renewal is effective as of Jan. 16, 2022.

While there is some concern amongst providers regarding what will happen to care and testing flexibilities once the PHE is allowed to expire, the Biden Administration has pledged to give states at least 60 days’ notice when they decide not to renew it further. This is the eighth time the declaration has been extended since it was first announced Jan. 27, 2020.
The No Surprises Act is now in effect as of Jan. 1, 2022. Despite efforts to inform the government of the downsides of certain aspects of this act, such as a payment dispute resolution process several provider advocacy groups are currently challenging in court, these out-of-network billing restrictions are now law.

While we’ve heard plenty of feedback from insurers and providers, billers themselves have often been left out of conversations surrounding the impacts of this new law. With this in mind, Mick Raich, President of RCM Consulting for LLS, recently spoke with leadership representatives of three national billing companies to gauge their response to these regulations and learn how it could impact the business of medical billing moving forward.
This new act, as with so many federal and state regulations before it, will certainly increase our cost to provide service. Ensuring compliance with the Good Faith Estimates and other requirements demand costly system and process updates we must endure. Further, we foresee an influx of activity related to arbitration of payment amounts as clients’ revenue is negatively affected.

-- Matt Zaborski, VP of Sales and Marketing, APS Medical Billing
The following article examines:

  • The major billing hurdles created by the implementation of the No Surprises Act.
  • How the profit margins of providers may stand to be impacted.
  • Whether this change could drive down reimbursement rates across the board.

1. Florida Society of Pathologists 48th Annual Pathology Conference

Feb. 18-20, 2022 in Orlando, Fla.
This email is brought to you as a service from Lighthouse Lab Services to provide quality and timely information that can improve your laboratory operations. We strive to maintain our position as the country’s premiere lab consulting firm and support your success.
The Lab Insighter is a monthly publication for Lab Owners and Decision Makers.
Contact us at:
(919) 443-6553