Laboratory Information Systems (LIS): What You Need To Know To Get Paid

By Sean McSweeney  bio Today, laboratory billing claims require more and more data to successfully get paid. One of the biggest reasons your claims may be getting denied is because you're … [Read more...]


How PAMA’s Effect in 2018 Molecular Diagnostic Reimbursement Will Make Labs More Money

By Sean McSweeney  bio The year 2018 is slated to be much brighter for molecular diagnostic labs as PAMA fee schedules show a higher payment rate and amount for many cancer genomics and … [Read more...]


PAMA-Geddon: Lab Industry Takes CMS to Court

The nearly three-year struggle between HHS and the lab industry over PAMA has entered a new phase. On December 11, the American Clinical Laboratory Association (ACLA) filed a lawsuit asking the U.S. … [Read more...]


No One-Size-Fits-All Answer for Frequency of Billing and Coding Audits

Q. How often should a laboratory conduct compliance audits of its billing and coding? A. The answer depends on many factors and will vary from provider to provider. The Office of Inspector General's … [Read more...]

Don’t Overlook Free Resources When Preparing Your Laboratory for ICD-10

The transition to ICD-10 is approaching fast and laboratories need to ensure they are prepared. While the Centers for Medicare and Medicaid Services (CMS) has indicated in answers to Frequently Asked … [Read more...]

The Art of Appeals: Don't Give Up Too quickly When a Payer Denies Your Claim

In the first part of this two-part series, we told you how to reduce the chances that payers would deny your claims. This month, you'll learn what you can do when, despite your best efforts, they … [Read more...]

Get Paid With Less Stress

Occasional denials from payers are just part of doing business for health care providers. But labs face challenges getting paid that clinicians don’t. In this two-part series, you’ll learn how to keep … [Read more...]

Ensure Regular training for Billing and Coding staff

Don’t overlook continual training of your billing and coding staff. It’s a compliance principle that the OIG emphasized in its initial compliance guidance for laboratories in 1998 and it is still just … [Read more...]

Whistleblowers Can Offer Statistical Sampling to Support Fraud Claims

A federal trial court in Florida has ruled that qui tam or whistleblower plaintiffs can use statistical sampling to prove fraud in a False Claims Act lawsuit. The court explained:“[N]o universal ban … [Read more...]

Stark and Anti-Kickback Issues Expected to Increase for Laboratories in 2015

Health care experts and attorneys predict 2015 will be a significant year for Health and Human Services Office of Inspector General (OIG) investigations of physician self-referral (Stark) and … [Read more...]