JVHL UpdatesMPAA

January 2015

Laboratory News

OIG 2015 Workplan: • Independent Clinical Laboratories: Review of billing without having

specified billing specifications at issue

FDA Oversight of Laboratory Developed Tests:• ACLA voices strong opposition during 2 day FDA public workshop

Lab News, (continued)

Modifier 59• Alive and kicking• Off-spring modifiers (XE, XS, XP, XU) should be used to describe

higher level of specificity

Drugs of Abuse• 63 + CPTs remain unpriced; tests are drug-specific• Continue to use 2014 codes• G Codes created to replace deleted 2014 codes

Lab News, (continued)

Medicare Incentives Reward Program & Provider Enrollment• Focus on program integrity issues• Don’t ignore or defer dealing with denials• Scrutiny over percentages of denied claims, reasons for denials,

length of time over which patterns develop, length of time provider has been enrolled in Medicare and “any other information CMS believes is relevant for that particular provider”

Lab News, continued

High Deductibles in 2015

• High deductible plan: $1300 for individuals, $2600 for families• Average employer plan deductible in 2014: $1217 ($584 in 2006)• Average patient cost-sharing increase 36% since 2012

JVHL News

JVHL Laboratory Co-pay and Deductible Billing Solution

JVHL News

• JVHL passed 2013-2014 Aetna annual audit with perfect scores• Community Cares Associates increased membership from 2,400 to

6,000 members• HAP Midwest Health Plan members benefits include BRCA testing• Harbor Health Plan of Michigan: agreement amended to include

Medicare Advantage and commercial exchange product• Meridian agreement will include Medicare/Medicaid dual: 4/1/15• Molina agreement includes Medicare/Medicaid dual: 1/1/15

And, finally…

• JVHL’s new and improved website launch date:• Monthly Satisfaction Surveys• Monthly Meetings• Shopping for venues

Thank You!