Tracks

Earn 10 CEUs

Path / Lab

Thursday, December 03 - Friday, December 04
Diana W. Voorhees

Diana W. Voorhees

MA, CLS, MT, SH, CLCP

Legislative and Coding Update: Considering Laboratory and Pathology 2016

Date and Time: December 3, 8:00 am to 10:00 am
CEUs: 2

Certified Professional Coder (CPC®)Certified Outpatient Coding (COC™)Certified Inpatient Coder (CIC™)Certified Professional Coder-Payer (CPC-P®)Certified Amulatory Surgery Center Coder (CASCC™) CredentialCertified Professional Compliance Officer - CPCO™Certified Physician Practice Manager (CPPM®)Certified Professional Biller (CPB™)Certified Professional Medical Auditor (CPMA®)American Association of Nurse Practitioners (1 AAPC CEU = 1 AANP CME)

Regulatory changes present annual challenges that impact billing, coverage, and payment. As time flies by, healthcare providers will soon see the proposed and perhaps final rule changes for the Medicare Physician Fee Schedule that also addresses the Clinical Laboratory Fee Schedule. Simultaneously, rule changes will be proposed and finalized for the Hospital Outpatient Prospective Payment System. The Affordable Care Act and the Patient Access to Medicare Act will introduce more changes. And, the OIG has ideas for compliance scrutiny. This session will focus on various regulatory issues that impact the laboratory and pathology industry.

Objectives:

  • Describe 2016 fee schedule changes for Medicare reimbursement.
  • Discuss procedural and diagnosis coding changes for 2016.
  • Identify government auditing programs and their purposes.
  • Discuss OIG agenda items for scrutiny.
Drug Testing: Coding and Coverage

Date and Time: December 3, 10:30 am to 11:30 am
CEUs: 1

Certified Professional Coder (CPC®)Certified Outpatient Coding (COC™)Certified Inpatient Coder (CIC™)Certified Professional Coder-Payer (CPC-P®)Certified Professional Compliance Officer - CPCO™Certified Physician Practice Manager (CPPM®)Certified Professional Biller (CPB™)Certified Professional Medical Auditor (CPMA®)American Association of Nurse Practitioners (1 AAPC CEU = 1 AANP CME)

The AMA provided a massive overhaul of coding and billing for drug testing this year. Confusion still exists regarding correct coding. CMS declined the use of the new AMA codes and retained a listing of various “G” codes. Of question is what will change in 2016. Will the AMA make changes to entice CMS utilization? Will CMS buy into CPT® coding? Will providers continue to use multiple coding mechanisms? Will coding clarity be found? These questions will hopefully have answers from the AMA and CMS for discussion in this session.

Objectives:

  • Describe current trends for drug testing including pain management practices.
  • Discuss coding changes that are applicable to drug testing for 2015.
  • Identify pertinent coverage and payment changes associated with Medicare fee schedules and those of other payers.
  • Highlight other coding and billing compliance challenges.
Molecular Diagnostics: Status of the World in Genomic Testing

Date and Time: December 3, 12:30 pm to 2:30 pm
CEUs: 2

Certified Professional Coder (CPC®)Certified Professional Coder-Payer (CPC-P®)Certified Professional Compliance Officer - CPCO™Certified Professional Biller (CPB™)Certified Professional Medical Auditor (CPMA®)American Association of Nurse Practitioners (1 AAPC CEU = 1 AANP CME)

2012 introduced a new coding structure for molecular diagnostics. CMS was unprepared to use these codes and other payers followed suit. Laboratories dealt with gap-filled reimbursement for the year and anticipated coding and reimbursement for 2014. Now in 2015, we have faced a reincarnation of the coding and gap filling for molecular testing issues. Laboratory developed tests and the FDA oversight have added to the molecular muddle. Coverage determinations are eroding standardization of provider testing. This session will provide updates for these issues and ancillary topics.

Objectives:

  • Discuss coding and reimbursement changes that are applicable to molecular testing for 2015 and 2016.
  • Identify pertinent coverage and payment changes associated with Medicare fee schedules and those of other payers.
  • Highlight coding and billing caveats and other compliance challenges.
Ancillary Pathology Testing: What’s New, What’s Old, and What’s Unknown

Date and Time: December 3, 3:00 pm to 5:00 pm
CEUs: 2

Certified Professional Coder (CPC®)Certified Outpatient Coding (COC™)Certified Inpatient Coder (CIC™)Certified Professional Coder-Payer (CPC-P®)Certified Professional Compliance Officer - CPCO™Certified Professional Biller (CPB™)Certified Professional Medical Auditor (CPMA®)American Association of Nurse Practitioners (1 AAPC CEU = 1 AANP CME)

The last couple of years have introduced variances in coding and billing for special stains, IHC and ISH stains, as well as morph metric analysis. CMS and the AMA established different guidelines for reporting these services. This session will discuss the updated use of these related codes and the impact of other ancillary issues such as CCI, MUEs, and LCDs.

Objectives:

  • Describe 2016 CPT® and HCPCS changes for pathology services.
  • Identify pertinent policies and issues affecting coverage.
  • Determine anticipated impact of CMS editing systems.
  • As time allows, delve into additional topics of interest or concern.
  • Reference Testing and Split Billing and Who Bills for What

    Date and Time: December 4, 8:00 am to 10:00 am
    CEUs: 2

    Certified Professional Coder (CPC®)Certified Outpatient Coding (COC™)Certified Inpatient Coder (CIC™)Certified Professional Coder-Payer (CPC-P®)Certified Amulatory Surgery Center Coder (CASCC™) CredentialCertified Family Practice Coder – CFPC™Certified General Surgery Coder – CGSC™Certified Professional Compliance Officer - CPCO™Certified Physician Practice Manager (CPPM®)Certified Professional Biller (CPB™)Certified Professional Medical Auditor (CPMA®)American Association of Nurse Practitioners (1 AAPC CEU = 1 AANP CME)

    Most laboratories refer certain procedures to another clinical or pathology laboratory for performance. There are numerous reference scenarios in place due to variances regarding testing sites. There are also regulatory concerns regarding “who can bill” for testing performed elsewhere. Hospital services typically require splitting the billing for professional and technical components of services. This session will review billing guidelines and nuances for attaining compliance.

    Objectives:

    • Review and discuss regulatory requirements for laboratory and pathology billing.
    • Exemplify testing and billing scenarios.
    • Discuss problematic billing issues.
    Ordering Issues and Concerns for Diagnostic Testing

    Date and Time: December 4, 10:30 am to 11:30 am
    CEUs: 1

    Certified Professional Coder (CPC®)Certified Outpatient Coding (COC™)Certified Inpatient Coder (CIC™)Certified Professional Coder-Payer (CPC-P®)Certified Evaluation and Management Coder – CEMC™Certified Family Practice Coder – CFPC™Certified Internal Medicine Coder (CIMC™)Certified Professional Compliance Officer - CPCO™Certified Physician Practice Manager (CPPM®)Certified Professional Biller (CPB™)Certified Professional Medical Auditor (CPMA®)American Association of Nurse Practitioners (1 AAPC CEU = 1 AANP CME)

    Requirements exist for differentiating and billing consults versus interpretations. As the OIG scrutinizes testing utilization in light of medical necessity, sensitivity increases regarding interpreting physicians’ orders for additional testing. Complete documentation is crucial to support medical necessity. Testing protocols may raise questions regarding standard of care. This session will introduce a discussion of these concerns.

    Objectives:

    • Describe ordering protocols for consults and interpretations.
    • Discuss best practices for testing documentation.
    • Identify OIG findings and current issues that lead to utilization concerns.