Volume XXV
May 2022

Full Focus: Understanding MolDX and Recent LCDs Impacting Reimbursement

Most labs performing infectious disease testing in MolDX regions are now required to register their laboratory developed tests or “expanded” panels that test for more than five targets in order to continue to receive reimbursement for these services. But what's the purpose of the MolDX program, and when does a lab know if it needs to apply for a Z-Code?

Please join us at noon, EDT, May 24 as we welcome Dr. Lori Millner, Laboratory Director and Technical Consultant for LLS, to discuss the following topics and more alongside Ann Lambrix, VP of RCM Consulting for LLS:

  • New LCDs impacting reimbursement for infectious disease testing.
  • A brief history of MolDX and a discussion on the program’s potential expansion.
  • How to know when your LDT or expanded panel requires a Z-Code.
  • Steps for receiving a Z-Code, including a breakdown of the required technical assessment.
1. How Has the Great Resignation Impacted the Lab Director Job Market?

The Great Resignation, caused in part by the COVID-19 pandemic, has impacted many industries around the country. The medical laboratory industry is among these, and as a result, there is a shortage of lab directors and pathologists.

In this video, Tara Luellen, Vice President of Lab Director Services at Lighthouse Lab Services, explains the state of the Lab Director/Pathology job markets and shares tips for making positions more appealing to candidates.
2. The Future of the Medical Lab: What Will Lab Testing Look Like Post-Pandemic?

As the COVID-19 pandemic winds down into an endemic, medical labs will need to pursue new avenues of testing.

In this video, Jon Harol, President of Lighthouse Lab Services, provides insight into several options for post-pandemic testing for medical labs, and discusses the upcoming shift from fee-for-service to value-based care.
3. Lessons from Executive War College 2022

Last month, the Lighthouse team attended the annual Executive War College in New Orleans and heard about the permanence of digital pathology, changes in the workforce, insight on reimbursement, and more.

In the blog below, President of RCM Consulting Mick Raich, who's been attending EWC since the 90s, highlights 10 key lessons he learned from this year's conference. As for his reoccurring takeaway, "change is the only constant," Raich says.

Deep Dive: Navigating Payment Disputes Under the No Surprises Act
Since going into effect on January 1, the No Surprises Act has raised a number of questions surrounding when patients can be billed for out-of-network services and how to negotiate with private payers to receive a fair reimbursement.

The Act requires commercial payors to reimburse for out-of-network emergency services in some qualifying instances, similar to if the services had been performed by an in-network provider. It also prevents providers from balance billing patients. Instead, providers are required to dispute payments with the applicable health plan via the Independent Dispute Resolution (IDR) process if the two sides can’t mutually agree on a fair out-of-network rate.
The IDR process involves 'baseball-style' arbitration, meaning each party brings one offer of a single payment amount to resolve the dispute. The arbitrator then determines the fairest offer, with no option to split the difference or negotiate further.

-- Tracy Augustyniak, Client Manager, Lighthouse Lab Services
The following article examines:

  • An overview of the IDR process under the No Surprises Act.
  • Steps-by-step instructions for seeking payment after providing out-of-network services.
  • A breakdown of how reimbursements are determined.

1. The American Society for Clinical Laboratory Science Annual Meeting

June 26-30, 2022, in Grand Rapids, MI.
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The Lab Insighter is a monthly publication for Lab Owners and Decision Makers.