February 2023
Full Focus: How Labs Can Prepare for the Shift to Value-Based Care

It’s no secret clinical laboratories are navigating an increasingly complex reimbursement landscape. However, beyond the current debates over clinical utility and test utilization lies a larger foundational shift: the move from fee-for-service payments to value-based care. With some experts projecting 100% of Medicare reimbursements could be value-based by 2030, now is the time to begin preparing your lab to adapt and thrive in this new environment. 
Join us at 12:00 PM EST, Wednesday, Feb. 22, for a roundtable discussion featuring guests from Clinical Lab 2.0 (Project Santa Fe Foundation), a coalition of laboratory leaders whose goal is to create a disruptive value paradigm and explore alternative business models that expand the role of diagnostic services in the future healthcare ecosystem.
During this webinar, our panel will cover:

  • The difference between fee-for-service and value-based care.
  • The projected timeline for widespread adoption of value-based care.
  • What this shift means for the future of the existing lab business model.
  • How labs can show value to Medicare and private payers.
  • The trajectory for labs to participate in at-risk models.
1. VALID Act Expected to be Reintroduced, PAMA Fix Again Being Discussed

A couple of key laboratory legislative issues that were put on hold at the end of 2022 now appear to be making comebacks as they seek new Congressional champions. Read our news roundup below for the latest developments on VALID and the Saving Access to Lab Services Act (SALSA).

2. Video: Exploring MolDX and Payer Guidelines for Molecular Testing

Is your lab still working to get a handle on whether or not your tests are impacted by MolDX coverage determinations? Do you have questions about the technical assessment process and when a z-code is eligible for reimbursement? View our recent webinar with AACC for a deep dive on these questions and more, including action steps labs can be taking to help display the clinical utility of their panels.

3. Celebrating Lighthouse's Biggest Achievements of 2022

In addition to our lab advocacy efforts, the Lighthouse Team also achieved a number of significant milestones we want to take a moment to celebrate. From helping labs stay well-staffed during the upheaval of the Great Resignation to building laboratories to help support underserved areas, check out a rundown of everything we accomplished last year!

1. What Labs May Be Missing About Timely Filing Write-Offs

A claim being denied for exceeding timely filing limits is an adjustment that should not be a frequent occurrence these days. With all the automation and electronic filing options, we should not see write-offs for past timely filing. However, if you are still doing things “old school” and sending hard copy reports by mail or fax, you will run the risk of timely filing on the billing of those reports/claims.

2. Specimen Collection Fee Increase

Don't forget, travel allowance fees for specimen collection received an increase for 2023. CMS bumped the general specimen collection fee up to $8.57 from the previous price of $3. Additionally, an extra $2 will be paid for specimens collected in skilled nursing facilities or by a laboratory on behalf of a home health agency.
3. The Cost of Directory Noncompliance Under the No Surprises Act

One of the less familiar provisions in the No Surprises Act is a requirement for in-network health plan provider directories to be maintained and verified no less than every 90 days. These rules apply to providers, facilities, and health plans, and offer no exemptions for any category of provider or facility. It’s a rule meant to be enjoyed by everyone!

Deep Dive: How to Effectively Negotiate Payer Contracts
While the future of healthcare may be value-based, the reality is most laboratories and pathologists still largely operate in a fee-for-service environment. Given that fact, understanding how to effectively track and negotiate your insurance payer contracts is a must for diagnostic providers looking to keep their patient populations healthy and business models thriving.

In this article, we review:

  • The current factors limiting reimbursements for small- and mid-sized labs.
  • Key payer contract clauses to know.
  • Tips for negotiating your next payer contract.
Ann Lambrix
“If you get a letter saying a payer is going to drop your reimbursement rate, you don’t have to just sign and accept it, or be afraid you’re going to lose something by fighting for fair payments.”

-- Ann Lambrix, VP of RCM Consulting, Lighthouse Lab Services
1. Clinical Lab 2.0 - Convergence of Lab Diagnostics and Population Health

Join fellow leaders from across the industry to explore the convergence of laboratory diagnostics and population health. Be a part of the movement to elevate the role of the clinical lab as healthcare transitions from volume to value! 

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The Lab Insighter is a monthly publication for Lab Owners and Decision Makers.