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CodeMap® Evolving Medicare Coverage Challenges for Hospital and Reference Labs::Recorded October 24, 2018

Evolving Medicare Coverage Challenges
for Hospital and Reference Laboratories

Wednesday, October 24, 2018
2:00 - 3:15 pm (Eastern Time)

As if the recent PAMA reimbursement cuts were not enough, CMS and Medicare contractors continue to implement aggressive coverage policies to curb perceived overutilization. Many of these policies are aimed directly at specialty testing such as drug/toxicology, cardiovascular/metabolic, and molecular pathology. Unfortunately, if your laboratory specializes in one of these areas, these restrictive policies can seriously affect your bottom-line. This CodeMap® Webinar will examine these restrictive and evolving policies as well as review the basics of Medicare coverage and related policies and procedures. 

The following topics will be discussed:
  • Drug/Toxicology Testing: Multiple MACs follow LCDs that aggressively limit the coverage of toxicology testing. Many of these policies prohibit custom panels. Recently, such LCDs have also addressed pharmacogenetics testing. 
  • Cardiovascular Testing: Multiple MACs, including Noridian, WPSIC, and Palmetto, have published coverage policies that govern the performance of cardiovascular risk and metabolic testing. These policies go beyond the standard lipid panel and cover markers such as lipoprotein subclasses, BNP, hsCRP, MPO, apolipoproteins, and many more. 
  • Molecular Pathology and MolDx: 23 states and territories are covered by MACs, which use the MolDx program to establish coverage for molecular pathology procedures. Laboratories must understand this program, which tests/laboratories must apply for coverage, and the necessary criteria for approval.
  • Molecular Pathology and Infectious Agent Panels: More and more MACs are creating coverage policies for panels of molecular pathology tests that determine the presence of infectious agents. Often these panels are considerably restrictive and limit the number of tests and/or agents Medicare will cover. 
  • Lab Developed Tests: Providers must also understand how Medicare and its contractors develop coverage requirements for laboratory developed tests including Advanced Diagnostic Laboratory Tests (ADLTs) and tests and procedures reported with new Proprietary Laboratory Assay (PLA) codes. 
  • The Fundamentals of Medicare Coverage: Finally, we will review the laws, rules, and regulations that govern the coverage requirements of federally funded health care programs. In addition, we will explain how LCDs and NCDs are continually subject to revision and/or deletion and what steps providers may take to protect their interests.
Price: $225.00

Video of Presentation and PDF Handouts.

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.