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...]

CMS Ignores Uniform Billing Committee, Creating Compliance Risks for Hospital Labs

In spite of concerns expressed by members of the National Uniform Billing Committee (NUBC) in a Jan. 21 letter to the Centers for Medicare and Medicaid Services (CMS), the agency went forward with its … [Read more...]

Government Health Care Budgets Include Increased Funding to Fight Fraud

Mandatory funding to fight health care fraud in the administration’s 2015 budget proposal is evidence that it remains a top priority among government agencies going forward, and compliance officers … [Read more...]

Fraud and Abuse Implications of the CMS Data Dump

Whistleblowers and their lawyers are likely already poring over the data contained in the data set released by the Health and Human Services Centers for Medicare and Medicaid Services (CMS) on April … [Read more...]

Compliance Perspective of the Doc Fix Law’s Section On Laboratory Payment Reform

Clinical laboratories may face substantial penalties for failure to submit complete and accurate data in the latest government move to revise the Clinical Laboratory Fee Schedule (CLFS). Section 216 … [Read more...]