October 2022
Full Focus: Culture vs PCR - The Evolving Lab Testing Market

While polymerase chain reaction (PCR) testing gained more mainstream recognition due to the role these tests played in the recent pandemic, many labs have still been slow to adopt PCR testing due to questions surrounding its clinical utility, cost, and other factors. However, the high level of accuracy of these tests and their subsequent ability to reduce unnecessary testing and improve treatment decisions make PCR a method every lab should explore. Join us at 12 p.m. EDT, Monday, Oct. 24, 2022, as we welcome our expert panel to discuss the pros and cons of PCR testing when compared against culture testing, including:
  • Clinical utility of PCR testing
  • Impact on workflows and reporting times
  • Common panels
  • Hybrid-culture/PCR solutions
  • Reimbursement comparisons

Please be advised there are currently fewer than 70 remaining seats available for this webinar. If you are unable to sign up, please check our YouTube channel for a recording following the live event.
1. Labs, Pathologists Aim to Delay 2023 Medicare Fee Schedule Cuts

As clinical laboratories and pathology groups prepare to operate outside of the Covid Public Health Emergency for the first time in years, many are turning an eye toward Medicare fee schedule cuts that could be reinstated after years of delays.

Annual Medicare and Clinical Laboratory fee schedule reductions for labs and pathologists are nothing new. However, asking providers to work for substantially lower fees after the fallout caused by the PHE will create an even greater strain for these physicians.

2. Announcing Lighthouse Payer Strategy Solutions

Lighthouse Lab Services recently got a bit brighter and better equipped to offer payer strategies for clinical laboratories.

As we move towards a unified brand, we’d like to reintroduce Burns Consulting Group as Lighthouse Payer Strategy Solutions, the go-to place for managed care consulting and payer contracting. Payer Strategy Solutions is a valuable addition to our services and strengthens our position as the comprehensive solution for all clinical laboratory needs.

3. The Pros and Cons of Adding Monkeypox Testing

Earlier this year, public health authorities in the U.S. and Europe alerted the public to the global proliferation of Monkeypox, a long-neglected disease that until this year was primarily limited to the areas of Western and Central Africa where the virus is endemic.

In this video, Jon Harol, President of Lighthouse Lab Services, discusses the pros and cons labs should consider before moving to add monkeypox testing to their test menu.

1. Case Study: Effectively Managing Timely Filing Denials

Timely filing is the contracted timeframe in which a claim must be submitted to the payer. These deadlines vary by payer and the payer contract should outline the timely filing limit for claims and appeals.

Billers and revenue cycle management teams need to keep in mind that most people responsible for processing appeals are not medically trained, so it must be made explicitly clear in the appeal why the claim should be paid.

2. Updated CMS Advanced Beneficiary Notice of Non-Coverage

CMS has announced the release of the latest Advanced Beneficiary Notice of Non-Coverage (ABN) effective 8/31/2022. Providers may issue ABNs to patients when they suspect Medicare will deny payment for a provided service.

The latest version’s primary change is an updated expiration date of June 30, 2023. While this is a minor change, providers are required to utilize the updated ABN effective Aug. 31, 2022. CMS advises that using outdated forms invalidates the patient notice and will disallow providers from billing the patient.

  • Starting August 31, 2022, all providers must utilize the updated ABN form
  • The updated version is Form No. CMS-R-131 (Exp. 06/30/2023)
  • This form is also identified in the footer as Form Approved OMB No. 0938-0566
  • Download the new form and obtain additional instructions by visiting the CMS ABN website.
3. New Medica Policy for Genetic and Molecular Testing

Beginning Dec. 1, 2022, Medica will implement a new payment policy for genetic and molecular testing. All providers billing for genetic and molecular testing services included in the policy must adhere to the coding recommendations in the Concert Genetics portal.

Tests included:

  • Molecular pathology (81105-81479)
  • Genomic Sequencing Procedures and Other Molecular Multianalyte -Assays (81410-81471)
  • Multianalyte Assays with Algorithmic Analyses (81490-81599)
  • Proprietary Laboratory Analyses (PLA) Codes

Deep Dive: How to Start a Toxicology Laboratory
Are you a behavioral health provider or physician seeking to expand your test menu by adding toxicology testing? Or perhaps you’re new to the industry but are exploring the possibility of starting a toxicology laboratory to serve the needs of your local community. Whatever the scope of your vision, it’s important to understand the basics of toxicology testing and how it could serve your patient population prior to beginning any build or test menu expansion.

Offering drug screening through an in-house toxicology laboratory also allows the physician to customize their panels and targets while avoiding additional unnecessary testing that may occur when shipping samples to reference labs. This strategy allows the physician to save time while also recapturing the revenue being generated for reference labs.
Elliot Labovitz
“Our technical team can develop custom panels of over 100+ drugs and analytes to help you start your toxicology lab. We also engage in method development to create solutions for a wide range of analytical techniques and materials.”

-- Elliot Labovitz, Chief Sales Officer, Lighthouse Lab Services
1. Texas Pain Society Annual Meeting

Oct. 28-30, 2022, Round Rock, TX.

2. Arizona Society of Pathology Annual Meeting

Oct. 29, 2022, Scottsdale, AZ.
CLIA Lab Director Openings
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The Lab Insighter is a monthly publication for Lab Owners and Decision Makers.