Lab Reimbursement Summit 2019

Lab Reimbursement Summit 2019 2019-09-04T10:42:55-07:00

Program subject to change. Please check back for updates.

Presenter: 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

Presenter: Robert W. Liles, Managing Partner, Liles Parker, Attorneys & Counselors at Law

Marketing activities that would normally qualify as ordinary business courtesies if extended to an actual or potential source of referrals in other industries, are often illegal in the context of Federal, State and private payor health benefits programs. In this session, we will discuss whether a number of the laboratory marketing practices that are currently under the government’s microscope. We will also examine Federal (such as the Anti-Kickback Statute and EKRA) and State statutes prohibiting kickbacks and patient inducements. We will also examine a number of recent civil and
criminal cases brought against laboratories and associated health care professionals and clinics, along with steps that your laboratory can take to better ensure regulatory compliance.

Key learning objectives:

  • Participants will be able to assess the current law enforcement environment and its impact on laboratories
    and affiliated health care professionals.
  • Participants will be able to explain how Federal and State laws regulate marketing activities aimed at referral sources.
  • Participants will be able to describe steps that laboratories should take to reduce their level of regulatory risk

Presenters: Michelle Matney, President; and Ann Lambrix, VP of Client Administration, Vachette Pathology

Do you want to take immediate, proven steps to collect more claim money, prevent many of most common claim
denials, and avoid 2nd denials?

In this session, you’ll take a close look at how more and more labs are employing data analytics in their billing process to unlock greater value from their lab data. Using actual examples, Vachette will share the proven techniques and best practices many of their clients are now using to decease denials, while at the same time making their denial management policies and practices far more efficient and effective.

Presenter: John Donnelly, CEO, FrontRunnerHC

Analyze the industry trends and policies within the healthcare landscape that are resulting in disruption and causing the uninformed labs to lose revenue. Guidance will be provided to help labs navigate through the shift in consumer buying power, the inflated number of self-pay patients and the recent proposed rules presented by CMS.

Tools and processes will be presented to build better patient engagement, obtain quality data, speed up the collections process and optimize lab’s bottom line. Coming out of this session you will have a better understanding of what’s is happening externally and how you can tackle it with a strategy internally.

Presenter: 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

Presenters: Sean McSweeney, Founder/President, Apache Health; Michelle Matney, President, Vachette Pathology; Ann Lambrix, VP of Client Administration, Vachette Pathology; and Robert W. Liles, Managing Partner, Liles Parker, Attorneys & Counselors at Law; John Donnelly, CEO, FrontRunnerHC

This closing panel session is a time for comments, discussions, and questions. All presenters are invited to participate when travel
arrangements make that possible.

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