Documentation Is Key: Medically Necessary Denials May Have Nothing to Do With Patient Care

When Medicare denies a claim because it is not medically reasonable and necessary, the decision may have nothing to do with whether the test is necessary and effective in the treatment of a patient. … [Read more...]

Florida Hospital Pays $26 Million in a Suit Filed by Auditing Firm

A whistleblower lawsuit filed by the president of a consulting firm hired by Shands HealthCare resulted in the $26 million settlement of alleged False Claims Act (FCA) violations, according to an … [Read more...]

G2 Compliance Perspectives: Revised Coverage Process May Be Step Backward for Labs

The laboratory community, which fought to get standardized national coverage decisions (NCDs) almost a decade ago so it would not have to deal with local coverage decisions (LCDs) that differed by … [Read more...]

Compliance Corner

Our hospital is taking a conservative view/interpretation of a coding service’s comment, insisting on receiving “narratives only” diagnosis information from physicians submitting orders for our … [Read more...]

Compliance Corner

My laboratory is confused about the application of the modifiers 59 and 91 for laboratory services. Can you briefly explain how each should be used? Both modifiers are used to report a repeat test or … [Read more...]

Caris Still on the Hook for Majority Of Whistleblower Allegations

A whistleblower suit that alleges Caris Life Sciences submitted false claims to Medicare, paid kickbacks to referring physicians and hospitals, and retaliated against an employee for reporting the … [Read more...]

G2 Compliance Perspectives: New Year Presents Compliance Officers With Challenges and Opportunities

One of the most important aspects of providing evidence to support that a laboratory’s compliance program is effective is through a process of constant activity, including annual reviews and updates … [Read more...]

News-At-A-Glance: Latest CCI Edits Update

The Centers for Medicare and Medicaid Services (CMS) updates the Correct Coding Initiative (CCI) edit files every quarter during the year. The latest batch of CCI edits was announced in a Feb. 28 … [Read more...]

Compliance Corner

How often should a laboratory conduct compliance audits of its billing and coding? The answer depends on many factors and will vary from provider to provider. The frequency of audits and reviews of … [Read more...]

Compliance Perspectives: Drugs-of-Abuse Testing: Noridian DL34754 Raises Critical Compliance, Legal Issues for Clinical Labs

Testing for drugs of abuse in clinical practice is a balancing act for the laboratory and health care practitioner. Testing too few or too many drugs or testing too frequently or not frequently enough … [Read more...]