Volume XIX
October 2021 - Top Stories:

1. Full Focus: Maximizing Genetic and Molecular Testing Reimbursement

As labs throughout the country continue to explore new revenue streams in the face of seemingly endless annual cuts from CMS and commercial payers, many are adding genetic testing and molecular diagnostics to their test menu. However, thanks to a patchwork of billing and reimbursement guidelines that vary across Medicare Administrative Contractor Jurisdictions and private payers, keeping track of what’s payable and where has historically been a difficult task.

Read on in this month's Lab Insighter to gain a better understanding of best practices when billing for genetic and molecular testing, items to be aware of before adding these tests to your menu, and new proposed coverage changes that could signal future shifts to the overall reimbursement landscape.

2. Webinar: Billing for Genetic and Molecular Testing - New Trends Impacting Future Reimbursement

Is your lab maximizing reimbursement for your molecular and genetic test menu? Join us as we discuss how to evaluate your proposed genetic and molecular test menu to ensure you stay within payer guidelines, and take a look ahead to offer some predictions on how this testing landscape could evolve within the next five to ten years.

During this webinar, we’ll discuss:

  • Evaluating your proposed test menu to account for payer/MAC variables when billing for molecular and genetic testing.

  • Various MolDX and managed plan requirements for billing these tests. What expectations do labs face for registration or prior authorization in order to be properly paid?

  • How newly proposed Local Coverage Determinations (LCD’s) could impact reimbursement in the near future, and what these moves toward conformity could meaning in the coming years.
1. Trending Issue: Lighthouse's CovidNow Assay Receives FDA EUA

Lighthouse is proud to announce our CovidNow RT-PCR assay has been granted Emergency Use Authorization (EUA) by the FDA. The EUA covers use for both symptomatic and asymptomatic patients, and is approved for home collection with a provider's order.

If you are seeking a replacement following the CDC's recent move to withdraw the EUA for its Covid kit, click below to learn more about our CovidNow and SalivaNow RT-PCR assays, which detect all major variants of Covid-19:

2. Three Things to Know When Billing for Genetic and Molecular Testing

Ann Lambrix, Vice President of RCM Consulting for Lighthouse and Vachette Pathology, often hears from labs interested in adding genetic and molecular testing services to their test menu, but haven't done the research to determine how to properly bill for these services in order to both get paid and maximize their reimbursement.

“What we aim to prevent is investing a lot of time, energy and resources developing your testing platforms and then finding out that certain payers won’t reimburse you,” Lambrix says. “It’s extremely important to do your research up front and make sure you intimately understand the landscape and insurance plans you’ll be dealing with.”

With that in mind, the following article offers three tips from Lambrix on key items to be aware of prior to billing for these services.

3. Adapting to the Post-Pandemic Modern Workplace

The Covid-19 pandemic has changed the face of a traditional workplace forever. Companies, by needing to arrange for employees to work from home for everyone’s safety, realized a lot of the work they thought could be done only in the in-person office setting could be done just as efficiently on a remote basis using modern applications and programs.

By using a Hybrid Work-Flex Model in response to the Covid-19 pandemic, Lighthouse Lab Services has enjoyed increased productivity and balance for its employees by arranging, when possible, the ability for most employees to work in an environment that yields the best result for both the employee and the company.

4. Free webinar: Viable Options for Your Post-Pandemic Lab

Join our upcoming live webinar, hosted by AdvancedMD, to learn about strategic options for CLIA laboratories birthed out of the Covid-19 crisis as you look to expand services. We’ll explain how you can utilize current assets to revalidate into new, higher reimbursement lines of clinical testing. You will gain market insight into the value of a Covid lab should you decide to sell. The webinar will also outline steps you can take to avoid compliance and fraud crackdowns as the OIG begins to scrutinize pandemic-related activity more closely.

Recently, President Joe Biden issued a mandate that requires all companies with 100 or more employees to have employees be vaccinated against Covid-19 or submit to weekly testing. Additionally, all health care facilities participating with Medicare or Medicaid must have employees vaccinated, with no opt-out exception for weekly testing.

While much of the early scrutiny has focused on whether this order will withstand coming legal challenges, one issue that hasn't seen as much discussion is whether the supply chain is prepared to handle the increase testing demand created by those who choose to forgo the vaccine. In this article, Mick Raich, President of RCM Consulting for Lighthouse and Vachette Pathology, explores what this increased strain could mean for laboratories and providers.
If you assume roughly 45 percent of the nation is currently not fully vaccinated, that leaves up to 45 million people who will need to take a Covid test weekly. We can assume many of these individuals will choose to receive the Covid vaccine and won’t require routine testing, but we must still consider how will we handle the additional testing volume created by those who decline to be vaccinated.

-- Mick Raich, President, RCM Consulting, Lighthouse Lab Services
The following article examines:

  • How this mandate will impact the lab supply chain.
  • A projected increase in the number of weekly tests to meet this new demand.
  • Who will cover the cost of testing.

1. Executive War College

The Lighthouse Lab Services team will be attending Executive War College Nov. 2-3 in San Antonio. If you're also planning to attend, we'd love to connect!

Additionally, Elliot Labovitz, Chief Sales Officer for Lighthouse, will be co-presenting a master class on how to decrease costs and increase revenue by bringing infectious disease testing in house. The session will take place from 7:30 a.m. to 8:20 a.m. on Wednesday, Nov. 3.
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The Lab Insighter is a monthly publication for Lab Owners and Decision Makers.
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