The battle between CMS and the lab industry over Medicare Part B pricing for lab tests could be on the road to resolution notwithstanding the ACLA's recent court loss. But even as the legal battle … [Read more...]
PAMA
Medicare Reimbursement: CMS Provides Needed PAMA Relief—But Newly Covered Hospital Labs Must Report in 2019
January 21, 2019
ENFORCEMENT
Provider Fined for Not Taking Compliance Measures Required by Its CIA
January 19, 2019
Case: Nearly 10 years ago, a new Affordable Care Act rule requiring labs and other providers to investigate their credit balances for potential Medicare overpayments took effect. In 2015, Pediatric … [Read more...]
CORRECTION
Correction: PAMA Relief—CMS 1450 14x TOB Labs DO Count!
December 20, 2018
Two articles appearing on the G2 website, "CMS Offers Some PAMA Relief But Not Nearly Enough" (G2 Compliance Advisor/Lab Compliance Advisor) and "2019 CLFS Offers Some PAMA Relief But Not Nearly … [Read more...]
MACRA REQUIREMENT
How to Adjust to the April 2018 Medicare Beneficiary Cards
July 9, 2018
By Sean McSweeney bio In a press release on May 30, 2017, the Centers for Medicare & Medicaid Services (CMS) commented regarding their fraud prevention initiative program and their … [Read more...]
OVERPAYMENTS
CMS to OIG: Get Back the $66.3 Million You Improperly Paid to Labs for Urine Validity Tests
April 10, 2018
As if times were not already tense enough for labs that bill Medicare for urine drug tests, the OIG ratcheted up the pressure another notch on Feb. 20 by issuing a new report chiding CMS for making … [Read more...]
OPIOIDS
Enforcement Trends: Opioid Crackdown Zeroes in on Urine Drug Testing-Today the Doctors, Tomorrow the Labs
February 19, 2018
A 67-year-old Michigan M.D. is the most recent doctor taken down in what has become a crucial part of the federal government's opioid drug crusade: urine tests ordered by prescribing physicians to be … [Read more...]
ANTI-KICKBACK
You Make the Call: Self-Disclosing Non-Compliant Arrangements with Large Physician Groups
January 9, 2018
SITUATION Fictional Med (FM), a large physician-owned clinic, is one of your lab's biggest customers. So your heart sinks when during an internal compliance audit, you discover that your lab has been … [Read more...]
CLFS 2018
CMS Ignored Congressional Intent in Implementing New Clinical Lab Payment System Under PAMA, ACLA Charges in Suit
December 11, 2017
The government agency that runs the Medicare program failed to follow a congressional directive to implement a market-based laboratory payment system, thereby jeopardizing Medicare patients' access to … [Read more...]
COMPLIANCE
OIG Calls on CMS to Do Better at Medicare Collecting Overpayments
October 24, 2017
The system Medicare uses to detect and recover overpayments isn't working as well as it should be, according to a new OIG report. The Overpayment Collection System CMS relies on special contractors … [Read more...]
REIMBURSEMENT
Medicare Reimbursement: CMS Issues New Medical Review Instructions to Contractors
September 29, 2017
On Aug. 14, CMS issued new marching orders to Medicare Administrative Contractors (Contractors). The message: Tighten up the way you target suppliers and providers for medical review. The Targeted … [Read more...]
