Ensuring that the lab services you bill for meet Medicare medical necessity requirements is one of the oldest challenges faced by lab compliance managers. And it doesn’t get any easier over time. The … [Read more...]
Compliance Perspectives
Medicare Medical Necessity Denials and How Your Lab Can Prevent Them
April 3, 2021
Billing & Collections
OIG Targets Pandemic’s Impact on Billing of Medicare Part B Lab Testing
February 22, 2021
Looking upon Medicare billing and payment of lab services with suspicion is and has always been part of the OIG’s organizational DNA. So, the fact that audits of Medicare Part B lab services during … [Read more...]
Labs In Court
LabCorp Can Sue Physician to Collect $117K Worth of “Pass-Through” Charges for Uninsured Patients
January 7, 2021
Case: Labs like LabCorp typically enter “pass-through” arrangements with physicians covering patients that lack insurance or are otherwise self-pay. The way it works: The lab bills the physician who … [Read more...]
REIMBURSEMENT
Labs and Private Payors Clash Over Reimbursement of COVID-19 Testing
November 27, 2020
Things are getting ugly. The unfortunate convergence of resurgent COVID-19 cases, lingering testing supply bottlenecks and Thanksgiving are once more stretching labs to the breaking point and fraying … [Read more...]
Labs In Court
NIPT Lab Company Pays $49 Million to Settle False Billing and Kickback Charges
September 11, 2020
Case: A month after going public, Progenity agreed to shell out $49 million to settle claims of overbilling and paying physicians kickbacks to order its noninvasive prenatal tests (NIPT). The case, … [Read more...]
Labs In Court
Connecticut Methadone Clinic Settles Urine Drug Test False Billing Charges for $354.3K
August 29, 2020
Case: A methadone clinic settled claims of overbilling the Connecticut Medicaid Program for urine drug tests for $354,367. Under state rules, methadone clinics receive a bundled weekly per patient … [Read more...]
Compliance Alert
Be Sure You Can Document Medical Necessity of COVID-19 ‘Add-On Tests’
August 4, 2020
Memo to Lab Compliance Managers: Brace yourself for what may become the next big federal false billing crackdown against labs, specifically labs performing COVID-19 tests. The OIG has let it be known … [Read more...]
Reimbursement
Payors Gradually Increasing Coverage of Liquid Biopsies but Obstacles Remain
July 28, 2020
Gaining the acceptance of insurers and payors for new tests and testing technology is a perennial challenge for laboratories and test developers. This has been especially true with liquid biopsy … [Read more...]
Labs In Court
Arizona Lab’s 20-Year Quest to Regain CLIA Certification Comes Up Empty
July 2, 2020
Case: CMS revoked an Arizona lab’s CLIA certification in 2000. Three unsuccessful appeals and one failed petition to the U.S. Supreme Court later—eight years in total—the seven CLIA deficiencies, … [Read more...]
Reimbursement
Feds Say Insurers Not Required to Pay for Employer Return to Work COVID-19 Testing
June 30, 2020
Since the public health emergency began, the US government has taken the position that insurers shouldn’t be allowed to make consumers pay for COVID-19 lab tests. But now comes news that insurers will … [Read more...]
