Practical Strategies for Maximizing Revenue and Minimizing Claim Denials in 2019
Whether you are an independent lab, hospital lab, or part of a large lab organization, it is absolutely critical to understand the latest reimbursement rules and regulations.
Just as important, it is critical to know how to benchmark your program to make sure you are getting maximum reimbursements allowed by law.
Join us in Las Vegas on December 6 for Lab Reimbursement Summit 2019: Practical Strategies for Maximizing Revenue and Minimizing Claim Denials and leading reimbursement experts will show you:
- How to make sure your lab is in compliance with the latest reimbursement rules and guidelines for diagnostic services, including the rules for new products
- How to accurately benchmark and evaluate the effectiveness of your reimbursement program
- How to identify overlooked opportunities to increase reimbursement revenue
- How to minimize claim denials for diagnostic lab testing
You will leave this Summit with the practical help you need to benchmark the effectiveness of your current reimbursement program, and understand how to identify opportunities to increase reimbursements while minimizing claim denials in 2019.
Registration is limited to just 40 attendees. Our 1-Day Summits allow you to discuss your questions and concerns with our experts one-to-one in an intimate, non-rushed setting. Register now to secure your seat!
Regularly $695.00 – Early bird sale price $495.00 You save $200.00 (14%)!
Registration and Breakfast
Welcome and Introduction
By Catherine Jones, Live Events Program Manager, G2 Intelligence/Plain Language Media
How to Gauge Reimbursement Success, Part 1
By Sean McSweeney, Founder/President, Apache Health
What is “reimbursement success?” Success is making as much money as possible as fast as possible. Then why is it so difficult to benchmark performance when it comes to revenue cycle management (RCM)?
Revenue cycle management (a.k.a. billing) is often viewed as a black box with no simple way to determine success. Since there are so many opportunities for error and loss while payers are trying to take advantage of labs, there is a lot of money lost in billing. How do you even know whether you’re doing great or are a poor outlier?
Key questions include:
- How much revenue is being lost? How can we even measure this?
- What is reasonable or even acceptable? What or whom are we comparing ourselves to?
- What can be done about it?
There are many variables and metrics/KPIs. But which actually matter? Which help your business? This presentation will help you to weed through what consultants or RCM vendors tell you and focus on what drives RCM success in your lab.
At the end of this session you will be able to:
- Ask the right questions to determine where money is being lost
- Identify key RCM processes to measure in your lab
- Develop a plan for capturing data and quantifying loss
Commercialization and Coverage for Novel Diagnostics
By Clarisa Blattner, Senior Director, MDx Support Services, XIFIN, Inc.
Early stage diagnostic and wearable diagnostic device companies face greater hurdles to commercialization and reimbursement than ever before. The combination of clinical assessment, market adoption, and reimbursement hurdles make it imperative to synch up all efforts within an organization for diagnostic providers from early-stage product development to commercialization and payor contracting. The objective of this presentation is to:
- Provide insight on the changing industry requirements for coverage and how lab process flows must adapt
- Discuss strategies to better collaborate and integrate with health systems to facilitate better care and coverage
- Provide critical updates on regulatory requirements for diagnostic companies
Critical Coding, Billing & Reimbursement Challenges You Face in 2019
By Diana Voorhees, Principal/CEO, DV & Associates, Inc.
Investigating your revenue cycle process and management is critical for proper billing and reimbursement. Compliance is a required component of each step in this process. Every laboratory and pathology service site will vary these steps depending upon testing specialty and volume of testing. But one stable requirement for accurate, timely and effective reimbursement is coding and billing. This session will highlight concerns during product development, latest impact of PAMA changes and other reimbursement issues.
Key learning objectives:
- Discuss the importance of coding, billing and ancillary issues during product development.
- Review and identify recent changes in the PAMA regulation and their effect on laboratory reimbursement.
- Determine preventive care mechanisms that assist with appropriate reimbursement.
2019 Payer Preparedness: Changes Ahead and Implications
By Steve Stonecypher, Partner, Shipwright Healthcare Group
The laboratory technology sector is growing rapidly, increased testing complexity, increasing costs and reduced funding are impacting payers, employers as well as all in the healthcare system. How are they dealing with rapidly growing costs while dealing with reduced funding? In this presentation, we will discuss market trends, both in federally funded programs (Medicare and Medicaid) as well as commercial insurers how they are handling this rapid growth and the impact on your laboratory.
Key learning objectives:
- Familiarize yourself with the key drivers in healthcare today.
- Understand how Medicare, Medicaid, and patient responsibility to benefit managers all impact our ability to proceed as a participating laboratory and impact your payments.
Denials Management: Do You Know How Much Money You are Leaving on the Table?
By Ellen Neiduski, Sr. Manager, GE Healthcare Partners
Denials management in the clinical laboratory can be difficult to track and measure, particularly in a hospital-based outreach program. Hospital based patient accounting often focuses on the high dollar claims, leaving the high volume, small dollar lab denials on the table.
This session will outline a few key strategies that you can use to help decrease denials before they happen as well as outline the elements of a successful denials management process.
At the end of this program, the attendee will:
- Understand the flow of patient claims and essential elements needed for processing
- Identify risk points in current processes that contribute to denials and suggested strategies to mitigate
- How to assess denials data for trends/client maintenance.
How to Gauge Reimbursement Success, Part 2
By Sean McSweeney, Founder/President, Apache Health
You have some tools and are now asking the right questions. You can even quantify some of the performance of key RCM processes. Now what? How do you measure the quality of your performance? The answer is benchmarking.
Which “typical” benchmarks are misleading or completely useless? For example, “AR days” is not the benchmark you should be looking at. It can be very deceptive and, in reality, does not matter as much as other KPIs. Which KPIs are truly valuable and actionable? Distinguishing between poor performance that isn’t controllable and what can be improved is critical.
Another important component is where to get data. A data point, without comparison, is not much better than having no data at all. Without comparison data, you have no idea where to set objectives or how urgent the need for improvement is. In this session we will also look at avoiding apples-to-oranges issues when comparing benchmarks.
At the end of this session you will be able to:
- Identify key metrics / KPIs to benchmark
- Find and analyze comparison benchmark data
- Determine if your RCM is not high-performing
Sean McSweeney, President, Apache Health
Sean McSweeney is Founder and President of Apache Health. He brings over two decades of industry experience in healthcare general management, marketing, sales, finance, and information systems. Prior to Apache Health, Sean was the President of Cobalt Health, a leading national laboratory billing company with over 125 employees. Sean led Cobalt to being the largest toxicology and molecular diagnostics laboratory billing company in the country. Prior to Cobalt, Sean was a Director at 4medica, a laboratory software firm in Los Angeles developing clinical information systems, especially online ordering and resulting for outreach laboratories. He developed corporate and product strategy, led marketing and communications, managed product development and was responsible for business development. Prior to 4medica, Sean managed the CT business for Toshiba America Medical Systems, leading it from $100 million to over $250 million per year in revenues. Before Toshiba, Sean held various sales roles for GE Medical Systems, where he received awards for regional and national sales performance. Sean holds an MBA with honors from the Columbia Graduate School of Business, as well as a bachelor’s degree with honors in electrical engineering from Dartmouth College.
Clarisa Blattner, Senior Director, MDx Support Services, XIFIN, Inc,
Prior to joining XIFIN, Clarisa utilized XIFIN RPM as a customer, most recently as Director Billing and Reimbursement at MDxHealth and before that at Clarient (acquired by GE Healthcare and then NeoGenomics). With more than 20 years of experience, she has specialized in claims, coding, error processing specialist roles and financial coordinating at US Labs and UC Irvine Medical Center.
Diana Voorhees, Principal/CEO, DV & Associates, Inc.
Having been Director of Sales and Marketing and Senior Consultant for a national coding and reimbursement consulting firm for nearly five years, Diana Voorhees developed DV & Associates Inc., a coding and reimbursement consulting firm providing consulting for physicians and facilities related to pathology and laboratory medicine. Ms. Voorhees has created a network of consultants with various health care backgrounds in order to provide quality, credible, and resourceful results for all consulting services. DV & Associates has been incorporated in excess of twenty years.
Ms. Voorhees initiated her career in laboratory medicine within the Division of Hematology (Doctors Wintrobe and Cartwright), Department of Medicine, at the University of Utah. She has also worked with the Division of Hematology at The Ohio State University, the Clinical Chemistry Department at Holy Cross Hospital in Salt Lake City, and the Special Hematology and Hemostasis Laboratory at the University of Utah. She spent 14 years as an Associate Clinical Professor and administrative faculty of Medical Laboratory Sciences in the College of Pharmacy at the University of Utah. During her last year and a half in academia, she was recruited as Program Director to design, implement and direct the program in cytotechnology in the Department of Pathology. Ms. Voorhees, upon leaving the University setting, joined Coulter Corporation and provided technical support, customer training, and education primarily in the western United States. She was recruited by a national coding and reimbursement consulting firm, Med-Index/Medicode (Optum now), where she spent nearly five years developing and marketing the consulting services for hospitals and other facilities, performing consulting engagements, providing seminars for national associations, enhancing product development, and serving on various corporate committees.
Ms. Voorhees has authored/edited several articles for professional publications including Compliance Report, a monthly column in Advance Newsmagazine (eleven years), MLO, Lab Medicine, ASCLS Newsletter, G2 Compliance Report, National Intelligence Report, and the Laboratory Compliance Insider newsletters. She has provided numerous seminars, teleconferences and audio conferences for various companies and organizations including ASCLS, AABB, CLMA, MGMA, AACC, ASCP, HFMA, University of Texas, University of South Dakota, Coulter Corporation, Laboratory Institute, G2 Reports, Miles, Inc., Business Network, AAPC, Coding Institute, Metropolitan Chicago Healthcare Council, Greater New York Hospital Association, The Greater Cleveland Hospital Association, Citation/Cerner Computer Systems, Dade Behring, United Communications, etc. Additionally, she completed a chapter on coding and reimbursement for a text book on laboratory administration, and served on editorial boards for Laboratory Compliance Insider and G2 Reports. Ms. Voorhees consults in pathology and laboratory medicine.
Steve Stonecypher, Partner, Shipwright Healthcare Group
Prior to Shipwright Healthcare Group, Steve held a senior management position with American Pathology Partners, developing and deploying a patient centric value based managed care market position. He also spent a number of years at Solstas Lab Partners, developing and implementing a managed care strategy for growth for a 500M company as well as beginning his career at LabCorp where he held various positions with increasing responsibility. He holds a Bachelor of Science degree in Healthcare Administration from California State University at Long Beach and a Master of Business Administration, Finance from Houston Baptist University.
Ellen Neiduski, Senior Manager, GE Healthcare Partners
Ms. Neiduski has more than 30 years of progressive management experience in healthcare, spanning multi-hospital performance improvement engagements, focused department level operational assessments and action planning, as well as subject matter expertise in laboratory operations. She has a positive track record of building effective teams through collaboration, accountability and mutual respect for each team member’s unique contributions and for effectively utilizing diverse staff with varying levels of skill and education.
Ms. Neiduski was the Director of Laboratory Operations with Quest Diagnostics where she oversaw technical operations of the Cambridge business unit processing 17,000 requisitions per night, developed management team members, and was responsible for 185 FTEs and operating revenues of $210 million/year. She has also led projects ranging from multi-laboratory consolidations and laboratory design and renovations, to interim management and information systems installations. She has extensive experience as an Laboratory Consultant and has provided interim management expertise, conducted regulatory compliance audits and remediation, and performed operations assessments and general consulting assistance for several nationally recognized firms as well as private clients. Ms. Neiduski has also helped clients regain regulatory accreditation from the Centers for Medicare and Medicaid Services, resolving deficiencies and implementing regulatory compliance. She has functioned as the project manager for several laboratory information systems installations and has lead numerous improvement projects using Six Sigma tools.
Ms. Neiduski has also served as a team member of a national, interdisciplinary team whose purpose was to define the future organizational structure of one of the largest laboratory companies in the country.
Ms. Neiduski holds a Master’s degree in Business Administration from Assumption College, a B.S. degree in medical technology from the University of Massachusetts and Certificates in healthcare and laboratory management.