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...]

Billing & Coding

AMA Creates New CPT Code 87426 for COVID-19 Antigen Testing

June 30, 2020

On June 24, the American Medical Association Current Procedural Terminology (CPT) approved new CPT code 87426 to report COVID-19 antigen tests, which use immunofluorescent or immunochromatographic … [Read more...]

Billing & Coding

CMS Issues Reminders for Billing COVID-19 Specimen Collection & Symptom/Exposure Assessment

June 29, 2020

On June 18, CMS offered up some guidance on billing Medicare for COVID-19 symptom and exposure assessment and specimen collection performed on and after March 1, 2020: Use CPT code 99211 to bill … [Read more...]

Medicare Reimbursement

CMS Waivers Expand COVID-19 Testing Coverage Rules

June 1, 2020

On May 1, CMS issued regulatory waivers temporarily expanding coverage and clarifying billing of COVID-19 testing for Medicare and Medicaid beneficiaries during the public health emergency (PHE). Here … [Read more...]

Labs In Court

Colorado MDs Pay $55K for Taking Specimen Processing Fee Kickbacks from HDL and Singulex

May 28, 2020

Case: Two physicians and their family medical practice have agreed to fork over $54,982 to the OIG to settle claims of soliciting and accepting illegal remuneration from lab companies Health … [Read more...]

REIMBURSEMENT

Billing & Coding: CMS Sets Rules for Medicare Coronavirus Testing Reimbursement with Private Payors Expected to Follow Suit

March 17, 2020

Good news for labs that are testing Medicare patients for the SARS-CoV-2 virus that causes coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Real Time RT-PCR Diagnostic Test … [Read more...]

Labs In Court

Texas Lab Loses $30.6 Million Whistleblower Suit over False Billing of Technician Travel Mileage

March 15, 2020

Case: A case that began as a whistleblower complaint by a competing lab ended with a $30.6 million judgment against a Texas lab for falsely billing Medicare for travel reimbursements. In addition to … [Read more...]

Labs In Court

Failure to Give Documents to Hospital Auditor Costs Lab Its Right to Be Paid for Test

March 8, 2020

What Happened: Blue Cross Blue Shield (BCBS) initiated a billing audit of an Alabama hospital after noticing its average urine drug tests had spiked from 30 to 1,100 per month. The hospital asked its … [Read more...]

Billing & Coding: Use New HCPCS Code U0001 to Bill Medicare for CDC Coronavirus Test

March 2, 2020

Good news for labs that are testing Medicare patients for SARS-CoV-2 using the newly approved Centers for Disease Control and Prevention (CDC) 2019 Real Time RT-PCR Diagnostic Test Panel (and … [Read more...]


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