Practice Group

Clinical Laboratory

Improving operational performance, payment and compliance through effective and efficient services and solutions.

Clinical Laboratories perform a critical function in the healthcare marketplace, and when in-house can generate valuable revenue for hospitals, health systems and other providers. As the regulatory and reimbursement landscape evolves it is essential laboratories to stay current to comply with law and maintain their licenses and accreditations, while providing quality services and generating the most value possible. Granite GRC’s professionals partner with clinical laboratories to improve their success through efficient and effective laboratory operations, strong reimbursement and consistent compliance.

“Over the past three years Eurofins Clinical Diagnostics has turned to GRC for coding and reimbursement guidance across our North American locations. In addition to effective reimbursement strategies and advice across our payors, they provided valuable and cost-effective documentation, coding and billing auditing services. Their reimbursement and auditing experts are some of the best I’ve seen in the industry, and their high level of customer-focus and service helps us to consistently drive and sustain our revenues. Granite not only helps us to achieve our strategic goals with a high level of expertise combined with easy to implement, practical solutions, but their team of certified coders provide sound, compliant and defensible coding guidance that has not only helped us avoid problems but overcome payor audits successfully. I highly recommend this skilled team to anyone looking for highly professional, third-party expertise.”

-from Dean M. Tassone, Vice President, Market Access Eurofins Clinical Diagnostics

Addressing Needs and Challenges

Granite GRC utilizes consultants with diverse backgrounds and real world, hands-on experience in the laboratory field, including clinical laboratory operations and compliance in large hospital systems, niche genetics laboratories, and full service independent commercial laboratories with the most complex test menus. Our seasoned professionals help clients navigate the impact of operational decisions on compliance and the impact of compliance initiatives on operations.

    • Documentation, coding and billing assessments
    • Chargemaster CPT/HCPCS code assessments
    • Test utilization and pricing analyses
    • Risk assessment/management
    • Laboratory licensing and accreditation
    • Compliance and privacy program assessments and improvements
    • Coaching, consulting, part time and interim compliance and privacy officers

Products & Services

Documentation, Coding and Billing Assessments
Review claims throughout the revenue cycle including documentation of:

  • Order by the physician or other authorized ordering provider
  • Registration in the Laboratory Information System (LIS) and check for medical necessity
  • Result reporting
  • Coding
  • Billing and reimbursement

Chargemaster CPT/HCPCS Code Assessments

  • Assess codes the laboratory has assigned to individual tests, panels and profiles
  • Reviews may be triggered by internal policies requiring periodic audits of the entire test menu, published code updates (e.g., AMA, CMS), ongoing changes to the laboratory’s test menu, or at the request of management in response to industry enforcement actions

Test Utilization and Pricing Analyses

    • Periodic reviews of ordering patterns and pricing structure

    Risk Assessment/Management

    • Assist laboratories in assessing and mitigating identified risks, such as:

    – Billing/coding errors
    – Lack of medical necessity
    – Improper arrangements with marketing firms, consultants, or referral sources
    – Reference laboratory arrangements (e.g., fraudulent telemedicine orders)
    – Eliminating Kickbacks in Recovery Act (EKRA), compensation arrangements with sales and marketing personnel, and
       understanding the key similarities and differences from the AKS and Stark Law

    • Establish or evaluate risk management programs

    Laboratory Licensing and Accreditation

    • Accreditation gap analysis (PA DOH, CLIA, CAP, TJC)
    • Guidance on applications and changes to CLIA certificates, PA laboratory permits, and CAP/TJC accreditations
    • Evaluation of personnel qualifications
    • Assistance developing responses to inspection deficiencies
    • Review test requisitions and reports

    Compliance and Privacy Program Assessments and Improvements

    • Assess laboratory compliance programs for alignment with key guidance documents including the OIG Program Guidance for Clinical Laboratories and the DOJ Evaluation of Corporate Compliance Programs
    • Coaching, consulting, part time and interim compliance and privacy officers

    Meet the Clinical Laboratory Team Leads

    headshot-frank-mesaros

    Frank Mesaros

    Director, Laboratory Services

    Frank has more than 20 years’ experience in the healthcare industry. His extensive background with laboratories includes research, academic, hospital-based, and independent lab settings. Frank also brings his broad expertise in the areas of coding, billing, documentation compliance, and claims development. He managed a regional laboratory and served as director of the healthcare consulting division of a large accounting and consulting firm. A recognized expert in the coding field, Frank contributes columns to Healthcare Business Monthly and the membership journal of the American Association of Professional Coders (AAPC) on a frequent basis.

    Headshot of Clivetty Martinez, Senior Consultant at Granite GRC Consulting

    Brandy Frey

    Senior Consultant

    Brandy has over 24 years of operational and leadership experience in laboratory testing, compliance and privacy, quality, accreditation, performance improvement, human resources, education, logistical services, materials management, and facilities. Most recently Brandy served a large multi-regional clinical laboratory as Vice President of Support Operations, followed by her appointment to Chief Compliance and Privacy Officer. Brandy’s leadership and support focuses on optimizing resources and refining policy and practices while maintaining operational efficiencies, effectiveness and compliance.

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