Compliance Issues Permeate Discussions Throughout Lab Institute

During three days of presentations, compliance issues for laboratories and pathologists permeated most of the discussions. Beginning with a workshop on workforce issues, speakers addressed compliance risks that can arise in recruiting, hiring, managing and terminating members of the workforce. Panel discussions prepared laboratories for the compliance challenges they’ll face with new payment methodologies, regulation and oversight of new technologies such as next generation sequencing, laboratory developed testing and direct-to-consumer testing. Throughout the conference, concurrent and general sessions addressed compliance issues relating to reimbursement, managing data generated by diagnostics, and ensuring patient access to test results.

Health care attorney Karen Lovitch capped off a morning of general sessions addressing regulatory, reimbursement and policy issues by highlighting three key compliance hotspots for labs to watch out for—medical necessity, arrangements with physicians, and increasing coverage restrictions. Within those key issues, she also discussed increased individual accountability under the Yates memo, private payer enforcement, waiver of copayment amounts and surprise medical bill legislation that addresses patient bills for out of network services.

Lovitch was only one of several speakers to address the challenges raised by surprise medical bill legislation. This legislation protects patients from unexpected bills from out-of-network providers after they sought services from an in-network facility. For example, a patient seeking treatment at an in-network hospital might be billed separately by out-of-network labs, radiologists, or anesthesiologists. New York and California both have passed such legislation within the last two years and the issue is gaining national attention. Lovitch and other speakers cautioned labs to make sure they understand state laws and reimbursement policies that govern such out-of-network billing.