Representatives of Physicians Group Management (PGM Billing) recently returned from attending and exhibiting at Lab Institute 2017. This meeting, hosted by G2 Intelligence, brings together professionals from throughout the lab industry for three days of education and networking.
In this ever-changing, ever-evolving healthcare environment, many sessions focused on the top challenges facing laboratories. Here are four of the most significant identified by meeting presenters.
Labs are under increased governmental scrutiny concerning the Stark self-referral prohibition and federal Anti-Kickback Statute laws and regulations governing patient payment responsibilities. It is critical that labs develop a process through which a concerted, documented effort is made to collect patient deductibles and co-pays. An emphasis should also be placed on the training sales staff and education of referring providers on the importance of documentation.
Labs are experiencing increasing Medicare and commercial carrier audits. What do you need to do to protect yourself? Ensure your internal documentation and referring documentation adequately meet payer guidelines. Additionally, it is fundamental that you educate referring providers on the importance of documenting medical necessity as well as their obligation to provide copies of medical records to the lab.
The latest update to the Protecting Access to Medicare Act of 2014 (PAMA) brought with it bad news for labs: most high volume codes could see Medicare payment reductions of 10% or more. Even more bad news:Ssince most commercial payers have moved to a base fee schedule that uses Medicare, you can except them to push for lower rates as well. With reimbursement tightening, labs cannot afford to leave any money on the table. An emphasis should be placed on ensuring effective laboratory billing/revenue cycle processes.
With Palmetto GBA securing the contract to provide administrative services for the Medicare program in the Georgia region (i.e., Georgia, Alabama, Tennessee) and implementing the MolDX Program, labs in these states will need to secure Z-codes for their particular tests. The Medicare Part B provider transition effective date is Feb. 26, 2018, but Z-code applications can be submitted now.