Thursday, October 25
Special Lunch and Learn Session: Toxicology and Genetic Testing Audits and Defenses
Thursday, October 25
12:30 pm - 1:15 pm
Concorde Lexington Bunkerhill



Over the last five years, we have seen a significant increase in toxicology and genetic testing as well as Medicare and third party payor audits of these tests. It is important for those in the industry to know how to protect your laboratory from these audits and collateral consequences. This session will look at: 

  • The regulatory, reimbursement, and other legal challenges that confront laboratories that engage in genetic and toxicology testing;
  • Audit strategies that address issues of medical necessity and coverage determinations raised by payors, such as Medicare; and
  • New appellate reforms, including Settlement Conference Facilitation and the Statistical Sampling Initiative.

Attendees will learn:

  • Proactive steps that laboratories can take to reduce audit exposure;
  • How CMS applies medical necessity requirement to laboratories;
  • The documentation that CMS requires to successfully defend a laboratory audit;
  • Important information about the appeals process available to laboratories and new Office of Medicare Hearings and Appeals (“OMHA”) reforms that allow laboratories to settle cases; and
  • The defenses of waiver of liability and provider without fault which are particularly applicable to laboratories.

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