Clinical Laboratories and Payer Scrutiny: Increased Audits, Recoupment Actions, Litigation

Recording of a 90-minute CLE webinar with Q&A


Conducted on Wednesday, February 7, 2018

Recorded event now available

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Program Materials

This CLE webinar will provide guidance to healthcare counsel on compliance considerations for clinical laboratories. The panel will discuss how the Stark Law framework, Anti-Kickback Statute, and related exceptions and safe harbors apply to laboratory testing. The panel will also discuss the developments in compliance requirements for client account billing for laboratory testing and identify risks and issues commonly associated with payer audits.

Description

Laboratories are under more regulatory and payer scrutiny now than ever before. The OIG has called for clinical laboratories to take reasonable steps to ensure they are not submitting claims for services that are not covered, reasonable and necessary. When clinical labs are unable to demonstrate medical justification or provide documentation during claim audits, payers seek recoupment from the clinical labs.

Receiving payment for lab claims is a challenge for clinical laboratories and pathology groups, especially in light of tough requirements by health insurers and Medicare contractors that are causing more and more lab test claims to be rejected. Even if claims are resubmitted and paid, labs struggle financially.

More and more hospitals use third-party labs, but as a result of limited contracts, labs are billing under hospital payer contracts. These arrangements are eliciting increased scrutiny from both government and private payers. Labs must carefully navigate federal and state regulations to ensure compliance.

Listen as our authoritative panel examines compliance considerations for clinical laboratories. The panel will review the Stark Law framework, Anti-Kickback Statute, and related exceptions and safe harbors apply to laboratory testing. The panel will focus on developments in compliance requirements for client account billing for laboratory testing. The panel will also identify risks and issues commonly associated with payer audits, and share thoughts on how clinical labs can be prepared for payer audits.

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Outline

  1. Compliance considerations for clinical laboratories
  2. Developments in compliance requirements for client account billing for laboratory testing
  3. Risks and issues commonly associated with payer audits
  4. Information on how clinical labs can be prepared for payer audits

Benefits

The panel will review these and other key issues:

  • How are more and tougher payer audits raising compliance challenges for clinical laboratories?
  • What steps should clinical labs take to ensure compliance with requirements for client billing for testing?
  • What risks and other issues are associated with payer audits?

Faculty

Sullivan, Elizabeth
Elizabeth Sullivan

Member
McDonald Hopkins

Ms. Sullivan co-chairs  the firm’s National Healthcare Practice. She assists clinical laboratories,...  |  Read More

Tito, Courtney
Courtney G. Tito

McDonald Hopkins

Ms. Tito counsels and represents clients in government and private payer audits and other payer disputes, and...  |  Read More

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