By Adam M. Walters Walters Law, P.C. Pass-through billing arrangements are those in which labs send a test specimen to an outside lab for testing and then bill the patient’s insurer for the test … [Read more...]
Compliance Perspectives
How to Manage Liability Risks for Pass-Through Billing Arrangements
October 30, 2021
REIMBURSEMENT
Ensure Proper Billing of New FDA-Approved CLIA-Waived Tests
June 28, 2021
Reminder: Effective July 1, labs can bill Medicare for a number of new CLIA-waived tests approved by the FDA. Here are the key details you need to know to ensure maximum reimbursement and proper … [Read more...]
Billing & Coding
OIG Sounds the Alarm on Improper Billing of Lipid Panels & Direct HDL Tests
May 24, 2021
Medicare could and should have saved over $20 million in payments for medically unnecessary LDL cholesterol blood tests if CMS hadn’t been asleep at the wheel for the past five years. That’s the gist … [Read more...]
Reimbursement
OIG Sounds the Warning on Improper COVID-19 Vaccination Billing
May 10, 2021
Labs and providers that furnish COVID-19 testing and vaccination services need to look ahead and prepare for the massive federal false billing crackdown that is sure to come if and when the pandemic … [Read more...]
CPT Coding
AMA Creates New PLA Code 0247U for Sera Prognostics PreTRM Test
May 6, 2021
The most recent laboratory developed test (LDT) to garner CPT code recognition from the American Medical Association (AMA) is Sera Prognostics, Inc.’s PreTRM Test, a proteomic blood test for measuring … [Read more...]
Compliance Perspectives
Medicare Medical Necessity Denials and How Your Lab Can Prevent Them
April 3, 2021
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...]
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...]
