Semi-Annual

Diagnostic Coverage & Reimbursement Conference

February 7-8, 2023 | San Diego, CA | San Diego Marriott La Jolla

Semi-Annual

Diagnostic Coverage & Reimbursement Conference

February 7-8, 2023
San Diego, CA
San Diego Marriott La Jolla

Day 1 Agenda

Day 2 Agenda

Day One Agenda
Tuesday, February 7

8:00 REGISTRATION & WELCOME COFFEE

8:50 CHAIRPERSON’S OPENING REMARKS
John (JD) Donnelly, Founder & CEO, FRONTRUNNER HC

9:00 OPENING ICE BREAKER: SHARING INSIGHTS INTO EFFICIENT METHODS TO REMAIN UPDATED ON HEALTHCARE MARKET TRENDS IMPACTING REIMBURSEMENT
Through this interactive session, participants in the event are given the unique opportunity to meet with fellow delegates and speakers, all while exchanging tips on preferred methods to collect market intelligence, ultimately kicking off the event knowledge-sharing and networking platform.

9:30 PAYER ROUNDTABLE DISCUSSION: UNVEILING PERSPECTIVES INTO DIAGNOSTIC REIMBURSEMENT REQUIREMENTS
• Comparing coverage & reimbursement decision-making mechanisms
• Focus on the quality & quantity of evidence to demonstrate value
• Perspectives into partnerships with providers & value-based agreements
MODERATOR:
Christopher Ho, MYRIAD GENETICS
PANELISTS:
Dirk Slaker, OPTUM HEALTH SOLUTIONS
Krystal Revai, HEALTH ALLIANCE
Eugean Jiwanmall, INDEPENDENCE BLUE CROSS

10:15 COFFEE & NETWORKING BREAK

10:45 FIRESIDE CHAT: SHEDDING LIGHT ONTO LBM DIAGNOSTIC TEST REVIEW PROCESSES
With the prominent position that Laboratory Benefit Managers have progressively taken in the reimbursement landscape, laboratories and test manufacturers alike are eager to secure a deeper understanding of the review process itself and differing requirements from one organization to another. Through questions coming directly from the audience, LBM representatives in this session will provide replies enabling a clarified approach to diagnostic test value assessment.
Tara Burke, VP, Payment & Healthcare Delivery Policy, ADVAMED
Ben Horton, VP, Medical Director, AVALON HEALTHCARE

11:30 THE CRITICAL PATH: STRATEGIES TO MAXIMIZE REIMBURSEMENT VIA PLA & CPT CODES
• Evidence requirements for PLA vs Cat I CPT codes
• Applicable timelines & processes for code obtention
• Payer acceptance & coverage of PLA vs Cat I CPT codes
• Implications on pricing strategy for both coding pathways
Eric Lam, Sr. Director of Market Access, HULL ASSOCIATES

12:15 LUNCHEON FOR ALL SPEAKERS, SPONSORS & ATTENDEES

1:30 PANEL DISCUSSION: IMPROVING REIMBURSEMENT & PATIENT SATISFACTION BY ENSURING CLEAN ORDERS
• Common desire that payers, providers & labs may share: A clean order
• Critical points hindering clean orders:
» Inaccurate patient data
» Prior authorizations
» Medical Policy
• Proactive approach to problem-solving by leveraging smart technology
• Benefits in approaching reimbursement from the front end
• Reducing claims denials, wasted time & patient/physician dissatisfaction with a clean claim
MODERATOR:
John (JD) Donnelly, FRONTRUNNER HC
PANELISTS:
Ryan Hortin, MYRIAD GENETICS
Matt Collins, MEDLAB2020

2:15 MAXIMIZE INSURANCE REIMBURSEMENT USING ACTIONABLE ANALYTICS
• Reimbursement environment complexities for newer diagnostic tests
• Advanced analytics to pinpoint areas of improvement
• Actionable analytics beyond standard financial metrics & KPIs
• Varied & multidisciplinary approach to common actions to optimize reimbursement
• Examples of analytics triggering a change to the reimbursement strategy
Tom Cronin, VP of Client Services, QUADAX
Chad Miles, Director of Client Services, QUADAX

3:00 COFFEE & NETWORKING BREAK

3:30 WHOLE GENOME SEQUENCING – IS BIGGER BETTER?
• What is a Genome
• When is it important to test
• Pro & Con of testing
• Open dialogue on audiences thoughts
Debbie Windsor, VP Market Access, GENEDX

4:15 CLARIFYING THE NO SURPRISES ACT & IMPLICATIONS FOR LABS & MANUFACTURERS
• Rationale for & implementation of the act
• Areas of impact on laboratories & developers
• Legal considerations for a robust compliance strategy
• Opportunities & positive outcomes to expect
Brian Carey, Partner, FOLEY HOAG

5:00 FIRESIDE CHAT: PROS & CONS TO ADVOCATING FOR LABORATORIES IN THE WAKE OF MEDICARE & PAMA
• Realistic approach to Medicare & PAMA frameworks
• Clarifying lobbying initiatives from independent organizations
• Paths forward & projected outcomes in the short & long term
Tara Burke, ADVAMED
Rob Dumanois, THERMOFISHER SCIENTIFIC

5:30 CLOSING REMARKS AND END OF DAY 1

Day Two Agenda
Wednesday, February 8

8:00 REGISTRATION & WELCOME COFFEE

8:20 CHAIRPERSON’S OPENING REMARKS
Dean Paluch, CRO, WAVE HDC

8:30 PANEL DISCUSSION: MEDICAL NECESSITY—HOW TO DEFINE, MEET, & MAINTAIN IT
• Remaining abreast of medical necessity criteria & changes in them
• Determining payer needs with respect to medical necessity & how to meet them
• Maintaining the evidentiary base to remain medically necessary
MODERATOR:
Randy David, QURE HEALTHCARE
PANELISTS:
Artem Boltyenkov, SIEMENS HEALTHINEERS
Rob Dumanois, THERMOFISHER SCIENTIFIC
Jerry Conway, GENEDX
Mike Nall, BIOLOGICAL DYNAMICS

9:00 OPPORTUNITIES IN MERGING MEDICAL & PHARMACY BENEFITS TO ACHIEVE PERSONALIZED MEDICINE
• Breaking down barriers between medical & pharmacy to allow integration of personalized medicine
• Innovative approaches to bridge the relationship between the PBM & the health plan
• Deep dive into ongoing pilot programs enabling the bridge & expected outcomes
Paige Nardi, Executive Director, Market Access, SCIPHER MEDICINE

9:45 COFFEE & NETWORKING BREAK

10:15 PRACTICAL APPROACH TO THE APPLICATION OF PLA & CPT CAT. I CODE SETS
• Pros & cons to the use of PLA vs CPT Cat. I codes
• Payer feedback in the appreciation of one vs the other
• Real-life examples illustrating efficiencies gained with each set
Lee Hilborne, Corporate Medical Director, QUEST DIAGNOSTICS

11:00 OPTIMIZING EVIDENCE GENERATION VIA A SOUND APPROACH TO STUDY DESIGN
• Clinical study design most relevant to payers
• Realistic & defined approach to evidence targets
• Reaching the right type & amount of data
Samira Saad, Medical Access Partner, ROCHE DIAGNOSTICS

11:45 CASE STUDY: AUTOMATING PATIENT DATA COLLECTION & DATA CORRECTION PROCESS
• Bad data leads to decreased revenue & increased cost of reimbursement in laboratories
• Improving accuracy & reducing errors by automating patient data collection & correcting data
• Benefits of automation in reducing bad data & increasing revenue/cost savings in the reimbursement process
Seth Maheu, President/CEO, BIRDROCK LABORATORIES

12:30 LUNCHEON FOR ALL SPEAKERS, SPONSORS & ATTENDEES

1:30 REIMBURSEMENT FOR AI-POWERED DIGITAL PATHOLOGY: CURRENT STATE, GAPS & OPPORTUNITIES
• Potential frameworks to describe clinical, economic & practice value
• Addressing payor concerns & coverage criteria with evidence
• Current & emerging reimbursement pathways for AI diagnostics
• Review & impact of recent decisions by the AMA CPT & CMS
• Call to action for industry, providers & payors to advance AI adoption & coverage
Shivang Doshi, VP of Global Payor Relations & Reimbursement, PAIGE

2:15 DEMYSTIFYING THE CMS CLFS PRICING PROCESS
• New code obtention: Lack of timeline & outcome predictability
• Review of Medicare pricing process:
» Public Meetings & comment periods
» Advisory panel involvement
» Engagement with medical contractors
• Clarifying the crosswalk & gapfill pricing methodologies
• ADLT alternative pricing methodology & code obtention pre or post coverage
Erik Schulwolf, Associate, FOLEY HOAG

3:00 DISSECTING THE VALID ACT & IMPACT ON DIAGNOSTIC REIMBURSEMENT
• Review of the provisions & new IVCT category
• Impact on diagnostic test reimbursement
• Pivotal focus points in preparing for compliance
Michael Ryan, Partner, MCDERMOTT WILL & EMERY

3:45 CLOSING REMARKS AND CONFERENCE CONCLUSION

A Special Thanks to Our Sponsors

Join our LinkedIn Group to connect with your peers and stay up-to-date on all things Medical Device & Diagnostic Coverage & Reimbursement.

TELCOR is the proven leader of health care software solutions for revenue cycle management (RCM) software and services designed specifically for laboratories. TELCOR RCM, our SaaS solution, and TELCOR Revenue Cycle Services, our billing service, are designed to streamline workflow, improve collections, and provide real-time analytics. Our software and service solutions are designed for the unique challenges and requirements of laboratory specialties and the clients they serve. With full access to data, labs have complete visibility of their data and can track key performance indicators. No other vendor works as hard ensuring you get paid for the work you do.

Visit Sponsor Website

PatientRemedi® by FrontRunnerHC® is a SaaS solution that instantaneously provides accurate and complete demographic, insurance, and financial information for your patients. The software suite obtains, cross-checks, and fixes patient information in real-time, leveraging robotic process automation (RPA) tailored to your specific patient population and access to the largest payer network in the industry. All the information is aggregated for you to easily view in one place and is accessible through a workflow portal, APIs, and progressive web applications (PWA). Through integration, the information can also be automatically posted back to your existing LIS or billing system. PatientRemedi helps you ensure timely and accurate billing. Eliminating wasted time reworking claims means you and your team can focus on higher-value tasks. Getting it right the first time is better for your patients, your referring physicians, your staff, and your bottom line. Maximize your reimbursements while providing a positive patient experience with PatientRemedi.

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With 18 years of experience, Lighthouse Lab Services is a trusted partner of clinical laboratories across the country. Our team consists of 190+ professionals and industry experts, including 11 PhDs. Whether you are looking to start a lab or grow your current business, we help laboratories accelerate their success.

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Quadax provides revenue cycle management solutions and services customized to meet the goals of your health care organization. We partner with laboratories, DME providers, payers, hospitals, physician offices, and other providers to expedite payments and maximize reimbursement, improving your operational and financial performance. Whether your team is already experienced in revenue cycle, or just starting out, Quadax solutions, services, and business analytics give clients full control of claims management, reimbursement, denials, appeals, audits, patient access and more. While celebrating 50 years of industry leadership, Quadax provides partnership, operational transparency, personal training, and dedicated support to achieve exceptional outcomes for our clients.

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XIFIN is a health information technology company that leverages diagnostic information to improve the quality and economics of healthcare.

The XIFIN technology platform facilitates connectivity and workflow automation for accessing and sharing clinical and financial diagnostic data, linking healthcare stakeholders in the delivery and reimbursement of care.

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QURE Healthcare, a TRC Healthcare company, helps reduce variation in care, improve patient outcomes, and lower costs for life science organizations. Learn how we can help advance coverage and reimbursement, provide evidence of clinical utility, and accelerate bringing new diagnostic tools and devices to market.

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Shadowbox is a powerful instant automation platform built for healthcare. It works like a smart browser, connecting multiple healthcare applications on the fly. Our patented, HIPAA compliant technology ensures fast, accurate automation of healthcare workflows so that providers can improve patient care, while increasing revenue, reducing cost, and removing friction.

Shadowbox is putting an end to paper forms, faxing, costly EHR integrations and redundant data entry with the only solution that offers real-time integration at the time of order. Our mission is to make patient data easy to access and secure to share no matter where it resides.

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Hull Associates LLC was founded in 2007 with a core focus on strategic reimbursement and market access support for pharmaceutical, device and medical technology clients in all major global markets. Our key service offerings focus on market access, reimbursement and health economic strategies, execution strategies, evidence strategies, due diligence, government affairs, health policy, and strategic market assessments. Our firm includes full-time staff based in the USA and over 30 senior-level field partners in locations around the globe. Our entire team has worked previously in the medical technology industry, and all partners are seasoned experts in reimbursement and economic strategy.

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Wave HDC is healthcare's data curator for providers, billers, and their auditors. Wave’s data curation identifies, sanitizes, and verifies patient data for accuracy across multiple platforms through data preservation, facilitation, discovery and when needed, interrogation. This is done expediently, on the fly using a combination of artificial intelligence (AI), intelligent interfaces, and robotic process automation (RPA) that significantly reduces processing time and delivers results nearing 100% confidence versus the 30% confidence rate of most commercial systems using more traditional connections and logic. This creates efficiencies, reduces costs, eliminates keystrokes, and capitalizes on revenue and cash flow. Wave streamlines the complex patient and insurance data capture processes involved in medical billing, record updating, reimbursements, and compliance through a combination of AI and real-time in-memory analytics data technology.

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At Veranex, we can help you with concept through to commercialization by enabling:
• Accelerated speed to market
• Controlled development costs
• Development risk mitigation
• Market viability assessment

At every stage, we navigate our clients to realize efficiencies in cost and time with our integrated and comprehensive solutions.

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Since TrainingPros was founded in 1997, we have been dedicated to helping our clients find the right consultant for their projects. 25 years later, we are proud to have helped hundreds of clients complete their projects and thousands of consultants find great assignments. We continue to focus on helping our clients and consultants as well as our community as a certified women-owned, award-winning staffing company that works exclusively with Learning & Development professionals to match consultants to client projects.

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At Tipping Point Media, we pride ourselves on developing innovative, creative, and technically advanced virtual training and digital marketing solutions for the life sciences industry.

We push the limits of what's possible using Augmented and Virtual Reality to create revolutionary experiences proven to increase audience engagement and retention rates.

Our dedicated team of educators, medical experts, certified programmers, and digital renaissance innovators are committed to creating high-quality custom creations that bring your company's vision to life.

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VantagePoint Performance trains Salespeople to be more fluent and comfortable across different situations needing different sales approaches, and we train Sales Managers to be better coaches and team leaders, with more focus and less stress.

We’re different from the average sales training company because:

We don’t believe that one approach, one system, or one methodology is absolutely superior. All have something to offer, and the “best approach” or “best system” depends on the sales situation. This is what our applied, academic research tells us.
Our use of data science, specifically Machine Learning, helps us learn about our clients more meaningfully. We provide insights from each client’s data to help them understand what drives the success of their top-performing Salespeople and Sales Managers.
We are constantly feeding what we learn back into our training products, and we invest a bigger slice of our total energy into this innovation than the average sales training company. Our clients can access always-refreshed intellectual property and content through our training subscriptions.

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Policy Reporter, acquired by TrialCard in 2019, provides innovative healthcare software solutions to track payer policies in near real-time and enhances market access for the therapies patients need most. The company’s patented software-driven solutions include a suite of billing and reimbursement tools for providers and laboratories, market intelligence tools for payers, and a suite of market access solutions for life science companies. Its clients include some of the world’s largest pharmaceutical and healthcare companies.

Visit Sponsor Website

Semi-Annual

Diagnostic Coverage & Reimbursement Conference

February 7-8, 2023 | San Diego, CA | San Diego Marriott La Jolla

Semi-Annual

Diagnostic Coverage & Reimbursement Conference

February 7-8, 2023San Diego, CASan Diego Marriott La Jolla

Day One AgendaTuesday, February 7

Day Two AgendaWednesday, February 8

A Special Thanks to Our Sponsors

Join our LinkedIn Group to connect with your peers and stay up-to-date on all things Medical Device & Diagnostic Coverage & Reimbursement.

February 7-8, 2023
San Diego, CA
San Diego Marriott La Jolla

Day One Agenda
Tuesday, February 7

Day Two Agenda
Wednesday, February 8