Blog

COMPLIANCE

Are you keeping your email compliant with HIPAA?

By Ron Slyker bio If you are a lab manager, you have more than likely heard the term “HIPAA compliance.” Most relate it to the protection of patient health information (PHI) within the office, but HIPAA compliance extends beyond internal communications. Ensuring email is HIPAA compliant is one of the most overlooked components of HIPAA compliance. A common misunderstanding is that an email is secure when you are sending it. Nevertheless, if the right protective layers are not configured, this is not the case. HIPAA compliant email communication is a necessity in today’s technical environment. Encryption Email encryption is almost always mandatory to be HIPAA compliant. Simply put, when an email is encrypted, the contents are masked to everyone but the recipient. There are two types of encryption: Transport level:… . . . read more

Lab Safety

From ant men to giant men

By Dan Scungio bio In January of 1962, Tales to Astonish #27, a comic book, featured a scientist who had created a special chemical. This chemical, when put in contact with an object, would shrink it! When the scientist tried the concoction on himself, he shrunk to the size of an ant! In time this scientist became the Astonishing Ant-Man, a super hero and a founding member of the team known as the Avengers. He worked on his chemicals and eventually gained the ability to grow very large. He then became known as Giant-Man. It’s quite a transition from ant to giant, and the scientist, Henry Pym, was able to do much in both roles. Something similar can happen in the workplace as well when considering safety. If the correct… . . . read more

Compliance Perspectives

Medicare Medical Necessity Denials and How Your Lab Can Prevent Them

Ensuring that the lab services you bill for meet Medicare medical necessity requirements is one of the oldest challenges faced by lab compliance managers. And it doesn’t get any easier over time. The complication stems from the simple fact that, in most cases, labs perform but don’t order the services they bill for; those services are ordered by an unrelated physician. This creates an inherent tension between the sides to the extent that labs rely on ordering physicians to furnish the documentation needed to show that the services are medically necessary. The nature of medical necessity disputes has changed since the early years of Medicare because clinical labs must now submit a diagnosis code on Medicare payment claims, and ordering physicians must provide labs diagnosis or other medical information required… . . . read more

Reimbursement

CMS Closes the Free COVID-19 Tests Coverage Loophole

Getting Republicans and Democrats to agree on anything these days is a Herculean task, even during a global pandemic. One of the rare points of consensus is with regard to the notion that all Americans should be able to get free COVID-19 testing. Accordingly, the mandate that payors pick up the full costs of testing without charging copayments was baked into the bipartisan relief legislation that Congress adopted in response to the crisis last spring. Of course, things didn’t exactly go according to plan. Aided by CMS guidelines, payors were able to exploit an enormous loophole in the coverage policy to avoid paying for a crucial aspect of COVID-19 testing: screening of the asymptomatic. But now CMS has closed that loophole. Here’s a briefing of the new developments and their… . . . read more

HIPAA

Proposed HIPAA Privacy Rule: The 9 Changes That Will Have an Immediate Impact on Lab Operations

On Dec. 10, with just a few weeks remaining in its tenure, the HHS Office for Civil Rights (OCR) proposed a series of changes to the HIPAA Privacy Rule. Public comments on the proposed rule were scheduled to close on March 22. Unlike many of the other midnight healthcare regulations adopted by the Trump administration, the Privacy Rule changes remain on track. But the new administration wants a little more time to study them. So, on March 9, the OCR announced that it was extending the comment period on the proposed rule for 45 days until May 6. The 9 Key Changes The point of the proposed rule, which takes up nearly 100 pages worth of 3-columned Federal Register text, is to give individuals greater access to their protected health… . . . read more

LAB SAFETY

What Do We Say to Patients Who Ask about Our Team’s Vaccination Status?

By Paul Edwards bio As vaccinations continue to be distributed to more and more members of the American workforce, one of the recurring questions we are getting concerns how to respond to patients who ask about whether or not your team has been vaccinated. Patients might pose this question over the phone before their scheduled appointment, or might ask it to one of your employees during their visit. Your Employees’ Health Information Is Protected In response to such a question, it’s important to remember that your employees’ personal health information is protected in just the same way as your patients’ health information. Therefore, it is generally not a good idea to offer information to your patients that might expose any of your employees’ inability (or unwillingness) to get vaccinated. If a… . . . read more

The Business of Testing

Hospital Laboratories Take a Stand Against Controversial UnitedHealthcare Outpatient Reimbursement Policy

The cold war between hospital laboratories and the nation’s third largest health insurer, UnitedHealthcare (UHC), over reimbursement of diagnostic tests is getting hotter by the day. At the center of the conflict is a controversial new UHC policy that would require laboratories to meet the standards of its homegrown provider care quality and efficiency program to qualify for reimbursement. Hospitals are pushing back against the policy and have now asked the federal government to intervene in the dispute. The Reimbursement Challenge Payors of all stripe have a rich tradition of griping about the high costs of laboratory tests. A turning point came in 2014 when Congress enacted the Protecting Access to Medicare Act (PAMA) to mandate imposition of a market-based pricing regime for Part B Medicare laboratory test reimbursement. Although… . . . read more

Focus On

How the Transition from Trump to Biden Will Affect Federal Regulation and Reimbursement

“Meet the new boss. . . same as the old boss.” The Who’s “Won’t Get Fooled Again” is a rock classic; but as far as U.S. presidents and federal regulation are concerned, the “new boss” is almost never the same as the “old boss.” The typical pattern: The outgoing administration recognizes that its opportunity to impose its political agenda is running out and generates a final spasm of new regulation; the ingoing administration then reviews and in, many cases, revises or cancels those midnight regulations, not only because of its policy differences but also due to the fact that these regulations are typically rushed into effect without following the required notice and comment procedures. And that’s exactly how things are playing out on the healthcare front under the Biden administration…. . . . read more

Workplace Safety

The power of the pause for avoiding injury

By Dan Scungio bio The majority of laboratory injuries and exposures are preventable, and most of them occur because people are not paying close attention to the situation. They lose their situational awareness or were never paying attention to it from the start. Unfortunately, safety professionals spend a great deal of time investigating such incidents rather than focusing on preventing them. If the power of the pause was understood by more healthcare workers, there would be fewer dangerous incidents and exposures. One illustration of that power can be seen in a simple exercise. A group of people is asked to read aloud quickly a list of words that indicate different colors; green, red, etc. The words are read together at the pace of one second each, usually to someone clapping… . . . read more

FDA Watch

FDA Watch: Molecular Tests May Miss New SARS-CoV-2 Strains, Agency Warns

Like many viruses, the SARS-CoV-2 is a shape-shifter. And that may make it harder to detect. With this in mind, the U.S. Food and Drug Administration (FDA) is warning clinical laboratories and health care providers of the risk that genetic mutations to the virus may lead to false negative test results. The Diagnostic Challenge The first and vast majority of tests with FDA emergency use authorization (EUA) for SARS-CoV-2 are molecular assay designed to detect specific RNA sequences found in the viral genome. However, the SARS-CoV-2 virus mutates regularly, resulting in several genetically unique variants, each with different RNA sequences. The presence of SARS-CoV-2 genetic variants in a patient sample can potentially change the performance of the SARS-CoV-2 test. If a molecular test is not engineered to detect the particular… . . . read more

FDA

FDA Sounds Alarm on Potential Impact of Genetic Mutation on SARS-CoV-2 Molecular Test Accuracy

As if COVID-19 testing wasn’t challenging enough, the emergence of new variants has made the SARS-CoV-2 virus a moving target. With this in mind, the FDA is warning clinical labs and health care providers of the risk that genetic mutations to the virus may lead to false negative test results. In its Jan. 8 letter, FDA identifies specific molecular tests that have received Emergency Use Authorization (EUAs) whose performance could be impacted by SARS-CoV-2 genetic variants. The Diagnostic Challenge The first and vast majority of tests with EUA for SARS-CoV-2 are molecular assay designed to detect specific RNA sequences found in the viral genome. However, the SARS-CoV-2 virus mutates regularly, resulting in several genetically unique variants, each with different RNA sequences. The presence of SARS-CoV-2 genetic variants in a patient sample… . . . read more

Lab Safety

What will 2021 bring for lab safety programs?

By Dan Scungio bio As we say goodbye and good riddance to the year 2020, we hesitatingly welcome 2021. What will the new year bring? Can it be worse than the last year? Are we prepared to deal with what else may be coming? Did we learn lessons in 2020 that will help us? These are valid questions for everyone, and they apply equally to lab safety professionals. We dealt with PPE shortages, new and additional testing, staffing shortages, and even the fears felt by our co-workers. Some of these issues persist, but there are ways to deal with them. Maybe the past year made you feel like you and your staff didn’t have a strong enough grasp of biosafety practices in the workplace. After all, questions came up about… . . . read more

Lab Safety

“COVID captains” promote safety precautions

By Dan Scungio bio The year 2020 is roaring to a close, and COVID-19 is unfortunately still around. We have made changes to our lives at home, in public, and at work. Lab workers and other healthcare workers, in particular, made several changes early on with PPE use and work practices that are still in effect today. A great deal of work had to be done early on this year to provide information to staff in healthcare facilities regarding this updated safety information. At this point, the initial work that needed to be done by safety professionals has been completed. Education was given regarding safe collection, transport, and testing of specimens. Risk assessments have been performed for new testing platforms. Employees have been educated regarding the continued use of Standard… . . . read more

DOJ

EKRA Prosecution: What Does this Mean for the Laboratory Industry?

By Charles Dunham, IV, Shareholder at Greenberg Traurig, LLP & Benjamin Nipper, Associate at Greenberg Traurig, LLP In January 2020, the U.S. Department of Justice (DOJ) made its first public announcement of a prosecution under the Eliminating Kickbacks in Recovery Act of 2018 (EKRA) of a former manager of a substance abuse treatment clinic, who pled guilty to violating multiple federal health care fraud laws. News of the charge and guilty plea may cause concern to the laboratory industry because no regulations or guidance have been released since its enactment in October 2018, despite concerns raised by industry stakeholders to both Congress and DOJ that the statutory provisions are unclear and conflict with long-standing safe harbors under the federal Anti-Kickback Statute (AKS). While the DOJ has not secured a conviction… . . . read more

EMPLOYMENT LAW UPDATE

The Workplace in 2020: Political Talk, COVID-19 Violence, Executive Order

By Mike O’Brien bio Don’t forget labor relations rules when employees talk politics at work During this month’s contentious election season—with a highly polarized American electorate—many employers may be grappling with problems arising from workplace political discussions. Research by the Society for Human Resource Management (SHRM) has indicated that more than a quarter of workers report regularly talking about politics at work. Disputes and tension often result. Employers wishing to regulate political speech at work should remember that the National Labor Relations Act (NLRA) may affect their options. Although employees often assert that they have a First Amendment right to free speech, this is a misconception. The First Amendment restricts government action, not that of private employers. However, Section 7 of the NLRA gives employees the right to talk to… . . . read more

Employment Law Update

New COVID-19 Guidance for Your Lab from EEOC

By Mike O’Brien bio The Equal Employment Opportunity Commission (EEOC) recently updated its COVID-19 guidance page, addressing a number of issues. Here are some of them: On coronavirus testing, the EEOC said general testing administered by employers consistent with current CDC guidance will meet the ADA’s “business necessity” standard, and noted that employers should ensure that the required COVID-19 tests are accurate and reliable according to the FDA, CDC, and other public health authorities. If an employer wants to test only one employee, however, the employer should have a reasonable objective belief that he/she might have the disease. The EEOC says an employer can ask employees whether they have had contact with anyone diagnosed with COVID-19 or who may have symptoms associated with the disease, but should not phrase that… . . . read more

COVID-19

Back to the Foundational Facts of Lab Safety

By Dan Scungio bio Things have changed drastically over the past several months as the COVID-19 pandemic continues. Many adjustments to how we work and live have been made and it has become difficult to separate fact from fiction. Should masks and goggles be worn at work? What type? Can we eat together on breaks? Information about the pandemic is abundant on news outlets and social media. Not all this information is correct, there are many coronavirus myths and misconceptions that are promoted online. However, many people treat all this information as gospel—a dangerous practice for those working in the laboratory. How can laboratorians discern fact from fiction or opinion? There are at least two basic truths of safety we should never forget. These foundational facts can help us to… . . . read more

EMPLOYMENT LAW UPDATE

Here’s new guidance on COVID-19 and FLSA

By Mike O’Brien bio For managers in charge of HR, the so-called lazy days of summer have been anything but lazy, as they strive to adapt to the COVID era and stay up to date on seemingly constant new government guidances. The Department of Labor has provided more information for employers regarding pandemic-related wage and hour issues. Specifically, the agency answered questions about hazard pay, FLSA’s overtime and minimum wage exemptions, and what time is compensable with respect to pandemic-related telework arrangements: DOL notes that hazard pay is not required under FLSA, but may be required under state or local laws, collective bargaining agreements, or company policies. DOL makes clear that taking leave under the Families First Coronavirus Response Act (FFCRA) will not jeopardize an employee’s exempt status under FLSA’s… . . . read more

Lab Safety

3 signs nobody is paying attention to safety

By Dan Scungio bio The safety officer walked into the satellite laboratory and saw an employee scrolling through social media on her cell phone. Another employee was wearing mesh sneakers and chewing gum in the department. In the storeroom chemicals were stacked on high shelves and the aisles were blocked with empty boxes. The safety officer had come to perform an audit, but it was clear in a minute that the safety culture here was not great. Visual cues are a fast way to see that no one is paying attention to safety, but there are other methods as well, and it’s important to use them. Not paying attention to safety has consequences. 1 Visual Cues Picking up on visual cues is not a talent you should expect to perfect… . . . read more

Employment Law Update

COVID-19, immigrant worker, discrimination and DACA developments

By Mike O’Brien bio EEOC says no to COVID-19 antibody testing: The Equal Employment Opportunity Commission (EEOC) recently (6/17/20) updated its COVID-19 guidance to indicate that employers should not be requiring employees to submit to antibody testing. Here is the verbatim Q&A (found at EEOC Guidance): Question: (A.7.): CDC said in its Interim Guidelines that antibody test results “should not be used to make decisions about returning persons to the workplace.” In light of this CDC guidance, under the ADA may an employer require antibody testing before permitting employees to re-enter the workplace? Answer: No. An antibody test constitutes a medical examination under the ADA. In light of CDC’s Interim Guidelines that antibody test results “should not be used to make decisions about returning persons to the workplace,” an antibody… . . . read more

Employment Law Update

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

Lab Safety

How we return to lab and clinic “normal”

By Dan Scungio bio The evolving COVID-19 pandemic has changed the world – the way we educate, the way we conduct business, and the way we socialize (or don’t). In the lab and clinic settings, there are many practices and procedures that have changed or are now being questioned. Sometimes the answer evolves quickly, sometimes there is national guidance to assist with a particular issue, and sometimes your own facility or organization makes the decisions for you. As we begin a return to “normal” practices, as the pandemic starts to wind down, it’s time to address some issues that arose often in recent months but that should always be considered for employee safety. Q: Should nurses or other staff come into the lab department wearing gloves? A: No, it is… . . . read more

Technology

Choosing A Partner to Automate Your Compliance Department

By Kristi Williams bio Sometimes the obvious isn’t so obvious. And sometimes it takes fresh eyes to see what has been right in front of you all along. Such is the case with automation in healthcare. Today, healthcare organizations find themselves continuously challenged to keep up with changing regulatory requirements and to ensure that their business practices adhere to external rules and internal controls. That responsibility falls directly on the shoulders of the compliance department who is tasked with identifying risks that an organization faces and implementing controls to protect the company from those risks. The need for an effective compliance program is not new. It has been understood by health plans for years. What is new however is that an increasing number of health plans are turning to automation… . . . read more

COVID Restrictions Ease

Employment law changing on the fly in response to COVID-19

By Mike O’Brien bio COVID-19 has ushered in a variety of new, and fast-evolving employment law changes, from the Families First Coronavirus Response Act (FFCRA) to the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). EMPLOYEE RETENTION TAX CREDIT: The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) includes a tax credit for employers that retain employees during the COVID-19 crisis. The credit generally provides relief to employers of all sizes in the form of a refundable payroll tax credit of 50% of all “qualified wages” paid (up to $10,000 per employee) during the COVID-19 crisis if (i) operations were fully or partially suspended or subject to a shut-down order; or (ii) gross receipts declined more than 50% compared to the same quarter in the prior year. Note that for… . . . read more

Employment Law

Coronavirus pushing rapid changes in employer law

By Mike O’Brien bio Employer law is rapidly changing amid the coronavirus pandemic. For one thing, Congress has passed another coronavirus related law. The United States Department of Labor (DOL) has provided some helpful guidance and answered a number of questions about the recent expansion of the Family and Medical Leave Act (FMLA) and about the new paid sick leave law, see: DOL FFCRA Q&A. Here are updates: PAID LEAVE UNDER THE EMERGENCY PAID SICK LEAVE ACT (EPSLA): Employees of covered employers (private employers below 500 employees and certain public employers) are eligible for up to two weeks (80 hours) of paid sick leave for certain COVID-19 related reasons. If leave is because he/she is quarantined (by government order or a health care provider), and/or experiencing COVID-19 symptoms and seeking medical… . . . read more

COVID-19 Alternative Safe Practices

My PPE is Back-Ordered: Now What?

By Dan Scungio bio The COVID-19 pandemic is peaking in the United States, and many things are being affected in unprecedented ways. Schools are closing, business travel is banned, gatherings are canceled, and stores are out of…toilet paper. There are supply shortages that are peaking as well, and some of the items that have become hard to get include personal protective equipment (PPE). Does that mean we can work without it in the laboratory setting? Absolutely not, neither OSHA nor any other regulatory agency will put a halt to safety practices that protect workers in any setting. But what if you really can’t get the PPE supplies you need? There are some alternatives. One thing to remember is that PPE should be used wisely and efficiently, even when there is… . . . read more

Lab Safety

Coronavirus in the Histology Laboratory

By Clifford M. Chapman bio The current world health care concern over coronavirus (i.e., COVID-19) has generated many questions regarding many aspects of this fast spreading disease. It is important to address the subject of the affect, if any, of this disease on how we work in and operate histopathology laboratories. An important and timely article was published online in the Journal of Histotechnology 01 March 2020. The article “Coronavirus disinfection in histopathology” by Anthony F. Henwood (1) was referenced by Gayle Callis on the NSH Open Forum and has been granted open access. Everyone is urged to read the entire article. Herein is a review to provide the essential findings of the article. The author provides a brief history of the coronavirus outbreak and its relationship to previous outbreaks… . . . read more

Increasing Profits

Strategic planning needs to evolve over time

By Nick Hernandez bio Some of my counterparts have a firm belief that strategic planning is a rigid process which should occur once every three to five years. The process they undertake is often done during an off-site planning session with the outcome being printed up in a large three-ring binder. In less than six months, those binders are sitting on a shelf somewhere collecting dust, never to again see the light of day. I, on the other hand, believe that strategic planning should be a continuous process involving the ongoing adjustment of means and ends. We should also view planning as an evolutionary process involving continuous adjustment and improvement. We can think of strategic planning as a solution-by-evolution rather than solution-by-engineering. We should generally not view strategic planning as… . . . read more

Lab Safety

Doing What We’ve Always Done

By Dan Scungio bio Scenario: The reference cytology lab has always had limited storage space for supplies and specimens. They use tall wire racks to store the many liquid-based cytology specimen vials. The vials contain small amounts of flammable chemicals, and the shelves are seven feet high. They have followed this storage procedure for 10 years. It took Jan four years to get her clinical lab staff to a decent point of compliance with regard to PPE use. They were pretty good now about donning lab coats and gloves, and even the use of face protection while handling open specimens has improved greatly. There were, however, many staff members who refused to give up wearing mesh sneakers while at work. Given the amount of work she put in already to… . . . read more

Billing & Collections

Finding the “Backdoor” into Payer Networks

By Steve Selbst bio I am delighted to be able to share with you a key “secret to success” about payer contracting. Today’s article is about getting in the “backdoor” with payers and complementing your payer network by building your patient/customer base. In my journey navigating tens of thousands of payer contracts’ negotiations, it has become clear to me that there are times when a payer will close its network to certain provider types, based on its network need. Don’t despair; there are other “paths to Oz.” Certainly, there are ways to build value propositions and ways to escalate up the payer management chain. These are topics for another day. Today, we’ll talk about an even easier to implement alternative: complementary payers! Complementary payers What is a complementary payer? Looking… . . . read more

Employment Law Update

New overtime rule now in effect

By Mike O’Brien bio Jan. 1, 2020 was the deadline to comply with new FLSA overtime rule. At the end of September the Department of Labor issued its long-awaited final rule updating the salary level test for white-collar overtime exemptions under the Fair Labor Standards Act. Under the new rule, the minimum salary level for exemption is raised from $455 a week to $684 a week, or $35,568 annually. The change marks the first increase in the minimum salary level to take effect in more than 15 years. It is expected to bring overtime eligibility to over a million employees who are ineligible under the current threshold. Although the DOL released a final rule raising the salary level in 2016, the rule was blocked by a federal district court and… . . . read more

BILLING & COLLECTIONS

Accessions Disappearing or Not Getting Billed?

By Sean McSweeney bio Ever get that feeling that there should be more charges in the billing system? How many times have you or someone else said something like “we did 3000 samples last month, but we only see 2500 that got billed”? Are salespeople complaining that all their samples aren’t in there? How can you tell if they are just complaining, whether the referral source didn’t send as many as they think or claim (which we all know happens), or if there were more samples sent or received and instead of getting billed they are just going “poof”? Where can revenue be lost? Tons of places. Most people in the laboratory world are familiar with the concept that not all claims get paid. Everyone is used to this concept… . . . read more

BILLING & COLLECTIONS

5 ways to break down bureaucracies to get payer contracts

By Steve Selbst bio It is important to remember that payers are large companies, with protocols, policies and business practices. As with any large company, there are bureaucracies, and they are necessary to maintain the order and success of these organizations. Therefore, the first tip is to understand that to get contracted you need to identify the right department and right person to send your request to get contracted. This is usually the payer contracting department and payer contracts’ manager. Generally, you will be sending your requests to the payer contracts’ manager in your state. A common mistake is to—instead—send these requests to provider relations or to another department. This brings us to our second tip. That is, figure out the approach the payer is using to establish its fee… . . . read more

Why Cleaning Up Your Dirty Data is Critical to Clinical Interoperability and Financial Survival

By Gregg Church bio
Hospital-based and commercial labs are flooded with all types of mismatched patient data. However, disparate systems coupled with a lack of universally mandated data standards and protocols means that big data just gets bigger—and clinical interoperability challenges just get larger…

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