1. Lâle White, CEO, XIFIN, Inc. November 7, 2012
Annual CCLA Conference Reimbursement Workshop 2012
Lâle White, CEO, XIFIN, Inc.
November 7, 2012

2. Insurance Changes Bluecard Aetna Cigna Medicare State Medicaids
Routing of claims to plan where specimen was drawn
Must contract with each plan
Paying patient for out of network claims
Aetna
Terminates contracted providers across US to reduce network
Cigna
Reduced claims submission timeline 8/1/11 to 90 days (NY & TN days, TX 95 days)
Medicare
Reduces timely filing to 12 months from for 2012
State Medicaids
IL Medicaid timely filing to 180 days from 12 mos effective 7/1/12
NE Medicaid timely filing to 180 days from 12 mos effective 1/1/13

3. Fee Schedule 20% under Medicare at highest level
Medi-Cal
Fee Schedule 20% under Medicare at highest level
10% Medi-Cal Provider Payment reduction- retro active 6/1/11
Implementation of AB 1494 – New Rate Methodology
State Plan Amendment to CMS 9/28/12
10% reduction upon approval of plan retro active to 7/1/12
New rates targeted for 7/1/13

4. 2013 Reimbursement reduction – 5% on CLFS
Medicare
MAC Awards
Noridian
Palmetto GBA – RR Medicare
MolDx
CED
2013 Reimbursement reduction – 5% on CLFS
~3% (productivity impact & additional 1.75% cut)
2% Rebasing of the fee schedule
TC Grandfather clause expires
88305-TC rate reduced 52%
G0416 Caps payments for biopsies at 10 or more units
Saturation Biopsy code vs. Prostate Biopsy
2013 Procedure Codes and Reimbursement
CLFS
New physician interpretation code to be on PFS

5. 2013 OIG Compliance Plan Highlights
Monitor Part B billing practices for NHs
Medical Review of Provider claims with greatest CERT errors
Hemoglobin A1C ordered more than one in 3 months
Scrutinize growth in laboratory Part B billing

6. The Value Is the Information
Moore’s Law
$3B
$5K
1999
2011
2005
Cost to sequence
genome
Clinical
Value
Cost Per Genome
Information Value

8. WSJ – Sources of the Next American Boom Paradigm Changing Technological Breakthroughs Waiting in the Wings
Nanoculture
Quantum Computing
Extreme miniaturization
Cloud Crowd
Ease in sharing information
Big Data (i.e., monitoring every vital sign of sick patient every second)
Printing Dreams
3D printing transforming manufacturing
Bolted to big data & nanotech to produce human organs
Self-Health
Monitoring devices
Disease Management
Handheld Diplomas
Embedding education into the daily life

10. Thank You Lâle White, CEO, XIFIN, Inc. Join the Conversation:

11. Industry Perspective – Uncertainty of Coverage & Uncertainty of Payment Rate Stifles Investment
CPT code stacks Lack:
* Payor Clarity
NOC Codes Lack:
* Workflow automation
* Coding Flexibility
* Pricing Clarity
* Coverage Clarity
Palmetto MolDx
PTI/Z Codes
Lack:
* Coding Standards
* Coding flexibility once stacking codes are gone
MoPath and MAAA codes
* Expedited process
Investors require clarity on timelines and potential value of investment
Elimination of Stacking Codes Default to NOC
Lack:
* Workflow automation
* Coding flexibility
* Coverage Clarity
* Pricing Clarity

12. PWC National VC Association MoneyTree™ Report Q3 2011 Data Provided by Thomson Reuters

13. PWC/National Venture Capital Association; MoneyTree™ Report, Data: Thomson Reuters

14. Develop a Best of Breed – Stakeholder Collaboration to Establish Standards & Administrative Clarity
AMA CPT
Agile/Adaptable
Flexible/Granular
Clarity
Confirmation of Clinical Validity (CLIA or FDA)
Non proprietary
NIH Registry
Transparency
Comprehensive directory of services
Open on-line access
Alignment of missions
Data Sharing
MolDx
Centralized Technical Assessment
Clinical Utility
Standard process
Objective criteria
Equitable Pricing