Compliance Perspectives: Compliance Warning: Watch Out for 2015 Laboratory Drug CPT® Code Changes

The American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS) have posted the preliminary new, revised, and deleted CPT® codes for 2015. The Drug Testing and the … [Read more...]

Comparative Billing Report Identifies Special Stain Outliers

Approximately 5,000 individual providers of tissue exams by pathologists in August received a comparative billing report (CBR) that compared their billing patterns for immunohistochemistry (IHC) and … [Read more...]

Medicare Provides Details on How to Bill For Hepatitis C Screening

The Clinical laboratories should pay close attention to two new Medicare transmittals that explain how to bill for the new hepatitis C virus (HCV) screening benefit since claims that violate frequency … [Read more...]

Compliance Perspectives: Defending the Medical Necessity of Anatomic, Clinical Pathology Services

"Thou shalt bill only medically necessary services.” Even though the term medical necessity appears in nearly every coverage policy issued by payers and insurers, its precise meaning remains elusive. … [Read more...]

More Than Meets the Eye: Taking a Deeper Look at 2015 OIG Work Plan Analysis for Laboratories

It is an error to review the single item directly addressed to laboratories in the Health and Human Services Office of Inspector General (OIG) Work Plan for fiscal year 2015 and believe that only … [Read more...]

CMS Establishes New ‘X’ Modifiers for Use With Modifier 59

Laboratories need to be careful how they use modifier 59, Distinct Procedural Service, in 2015 because the Centers for Medicare and Medicaid Services (CMS) is trying a new tactic to ensure proper use … [Read more...]

Compliance Perspectives: It’s Time to Look Forward: Make a List and Check It Twice

Among the many tasks that a laboratory compliance officer must carry out, planning for upcoming compliance issues and anticipating regulatory challenges is as important as any other. This task is … [Read more...]

Compliance Perspectives: It’s Time to Look Forward: Make a List and Check It Twice

Among the many tasks that a laboratory compliance officer must carry out, planning for upcoming compliance issues and anticipating regulatory challenges is as important as any other. This task is … [Read more...]

Coming Changes for Clinical Laboratory Fee Schedule May Create New Compliance Risks

Labs need to brace for more changes in the reimbursement environment as the Centers for Medicare and Medicaid (CMS) is set to initiate a new process for setting the clinical laboratory fee schedule … [Read more...]


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