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Arizona Lab’s 20-Year Quest to Regain CLIA Certification Comes Up Empty
Case: CMS revoked an Arizona lab’s CLIA certification in 2000. Three unsuccessful appeals and one failed petition to the U.S. Supreme Court later—eight years in total—the seven CLIA deficiencies, which the lab owner continued to insist were invalid, remained unremedied and the $30,000 fine unpaid. In 2013, the owner sought new CLIA certification for the lab but the state refused to process the application unless and until the owner paid the fine and resolved the previous sanctions. A new round of appeals ensued and the case landed in an Arizona federal district court which ruled against the owner. Analysis: The CLIA law establishes a specific process for appealing the denial of certification under which a lab must first go to an Administrative Law Judge (ALJ) before it can go to… . . . read more
G2 Blog
Supreme Court ruling extends workplace protections to LGBTQ workers
By Mike O’Brien bio SEXUAL ORIENTATION AND TRANSGENDER STATUS NOW ARE PROTECTED CLASSES NATIONALLY: Federal civil rights law protects gay, lesbian, and transgender employees, the United States Supreme Court announced June 15 in a landmark ruling. The historic decision will extend workplace anti-discrimination and anti-harassment protections to about 8 million LGBTQ workers nationwide. The ruling also vindicates a position long taken by the federal Equal Employment Opportunity Commission (EEOC). It is a defeat, however, for the Trump administration, which opposed the EEOC. President Trump instructed the Department of Justice to argue that the provision of Title VII of the Civil Rights Act that bars discrimination based on sex did not extend to claims of gender identity and sexual orientation bias. This led to the odd circumstance where two parts of the same government argued for opposite… . . . read more
Feds Say Insurers Not Required to Pay for Employer Return to Work COVID-19 Testing
Since the public health emergency began, the US government has taken the position that insurers shouldn’t be allowed to make consumers pay for COVID-19 lab tests. But now comes news that insurers will not be put in that same position with regard to return to work screening conducted on employees by their employers. And while the plan is for employers to pay for that testing, labs that perform COVID-19 screening tests may get left holding the bag. FFCRA Rules for COVID-19 Test Payment The key piece of federal relief legislation, the Families First Coronavirus Response Act (FFCRA), required insurers to cover COVID-19 tests without imposing any copayments, deductibles, coinsurance or other patient cost-sharing. But the rule (Section 6001 of FFCRA) rule applied only to tests deemed “medically appropriate” by a… . . . read more
CMS Issues Reminders for Billing COVID-19 Specimen Collection & Symptom/Exposure Assessment
On June 18, CMS offered up some guidance on billing Medicare for COVID-19 symptom and exposure assessment and specimen collection performed on and after March 1, 2020: Use CPT code 99211 to bill for assessment and collection provided by clinical staff (such as pharmacists) incident to your services, unless you’re reporting another Evaluation and Management (E/M) code for concurrent services; The above guidance on code 99211 applies to all patients, not just established ones; Submit the CS modifier with code 99211 (or other E/M code for assessment and collection) to waive cost sharing; If you didn’t include the CS modifier when you submitted 99211, contact your Medicare Administrative Contractor so it can reopen and reprocess the claim; CMS will automatically reprocess claims billed for code 99211 that it denied due… . . . read more
The Next Round of COVID-19 Legislation: What It Will Take to Prevent a Second Outbreak?
The next wave of federal COVID-19 relief legislation is in the works and the lab industry is doing its level best to ensure that it includes the necessary support for lab testing that the previously laws failed to deliver. HEROES & Villains On May 15, the U.S. House of Representatives narrowly passed the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, a new $3 trillion COVID-19 stimulus bill. In addition to $75 billion to support diagnostic testing and contact tracing activities to monitor and suppress the COVID-19 virus, the HEROES Act would: Eliminate deductibles, copayments and other cost sharing for COVID-19 treatment (the way previous legislation did for COVID-19 testing); Provide $1 trillion to state and local governments; Expand family and medical leave and unemployment compensation; Establish a fund… . . . read more
USPSTF Recommends Hepatitis C Virus Infection Screening for All Adults
In response to a spike in hepatitis C virus (HCV) infection cases among young adults, the U.S. Preventive Services Task Force (USPSTF) revised its guidance and is now recommending that all adults, not just older ones get HCV screening. HCV Testing Trends The last time the USPSTF issued HCV screening guidance was back in 2013 when adults born between 1945 and 1965 accounted for an estimated three-fourths of HCV infections. Accordingly, the guidance recommended screening only for adults in that high-risk group. However, the incidence of HCV infection has grown roughly 3.8-fold between 2010 and 2017. Growth in the infection rate has particularly affected younger people, especially intravenous drug users in the age range of 20 to 39. Other the that have been hit hard include American Indian/Alaskan Native and… . . . read more