How Laboratories Play a Role in Member Benefits by Forming a Bridge Between the Ordering Provider and the Health Plan with Robert Pilarski, MS, LGC + Marissa Russell, MS, LGC + Gregory Nogle

In this session we will review how the laboratory and health plan work together in order for the patient to better utilize his/her member benefits. We will discuss the claims submission process, how medical necessity is determined, and the appeals process for genetic diagnostic testing.

Level of Instruction: Intermediate

Only the live session qualifies for CEUs but when possible, we host the recordings on our website and NSGC recommends participants to use their personal email instead of work email addresses to ensure they receive their CEU certificates.

Ambry Genetics is approved as a provider for continuing education program by NSGC and ASCLS P.A.C.E ® Program.

Robert Pilarski, MS, LGC | Presenter

Medical Affairs Director at Ambry Genetics

Robert Pilarski is Medical Affairs Director at Ambry Genetics working on aligning payer policies and national genetic testing guidelines. Prior to this he was a licensed and board-certified genetic counselor and Professor of Clinical Internal Medicine at the Wexner Medical Center and James Comprehensive Cancer Center at The Ohio State University. Mr. Pilarski’s clinical responsibilities included counseling patients and families with a variety of hereditary cancer syndromes. He has presented regularly at national and regional conferences and has served as an ad hoc reviewer for numerous medical and genetics journals. Mr. Pilarski was a past board member of the National Society of Genetic Counselors, and co-founder and past president of its Cancer Genetics Special Interest Group. Until joining Ambry Genetics he was the vice-chair of the National Comprehensive Cancer Network’s guidelines panel on Genetic/Familial High-Risk Assessment: Breast and Ovarian Cancers, which set testing and management guidelines for individuals at risk for hereditary breast and ovarian cancers.

Gregory Nogle | Presenter

Vice President of Market Access for Ambry Genetics

Greg Nogle has an extensive history within the market access industry and is currently the Vice President of Market Access for Ambry Genetics, a Realm IDx company. In this role, he is responsible for leading the team in integrating coding/coverage initiatives with CMS/Medicare contractors and driving reimbursement strategies for commercial and government payers. In addition, he directs coverage efforts aligned with internal and external clinical stakeholders to drive policy changes within molecular diagnostics. In his career, Greg held positions on the payor side, creating clinical and ancillary networks under risk and alternative payment models. He has also held leadership reimbursement positions in numerous industries, including medical device, therapeutics and diagnostics with such companies as Insulet Corporation, Roche Diagnostics, and Memorial Healthcare. He holds a B.S. from LSU where he focused on economics and history.

Marissa Russell, MS, LGC | Presenter

Medical Policy Director for Market Access at Ambry Genetics

Marissa Russell is the Medical Policy Director for Market Access at Ambry Genetics. Marissa is a licensed and board-certified genetic counselor with extensive genetics experience in the clinical, health-plan, and industry settings. Clinically, she has worked serving rural communities throughout the state of Montana. Additionally, Marissa led the genetics program at Humana, Inc. where she focused on contracting initiatives for national laboratories and on creating an analytical approach to reducing administrative burdens and streamlining processes. In her current role, Marissa utilizes her prior knowledge base to facilitate collaboration for medical policy alignment and optimize the use of patient medical benefits. As a forever patient advocate, Marissa strives to reduce burdens for the right patient to receive the right genetic test at the right time.