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

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

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

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

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...]

Labs in Court

Drug Abuse Treatment Owner Guilty of $57 Million Drug Test Pass-Thru Billing Conspiracy

Case: The owner of a northern Florida substance abuse treatment center pleaded guilty for his role in a $57 million pass-through lab testing billing and money laundering scheme. The way it worked: The … [Read more...]

Billing & Collections

Finding the “Backdoor” into Payer Networks

By Steve Selbst bio  I am delighted to be able to share with you a key “secret to success” about payer contracting. Today’s article is about getting in the “backdoor” with payers and complementing … [Read more...]

Labs In Court

Lab Uses Billing Info of Another Lab to Get Around Payment Restrictions

Case: In 2015, Kentucky Medicaid and private payors began having doubts about the legitimacy of urine drug test claims submitted by CAL Laboratory Services and restricted payments to the toxicology … [Read more...]


Accessions Disappearing or Not Getting Billed?

By Sean McSweeney bio Ever get that feeling that there should be more charges in the billing system? How many times have you or someone else said something like “we did 3000 samples last month, but … [Read more...]


Texas Health System Fined $431K for Falsely Billing Genetic Tests  

Case: The feds contend that between 2016 and 2018, Decatur Hospital Authority (d/b/a Wise Health System) sent samples from surgical patients to Tennessee labs for medically unnecessary genetic tests. … [Read more...]


5 ways to break down bureaucracies to get payer contracts

By Steve Selbst bio It is important to remember that payers are large companies, with protocols, policies and business practices. As with any large company, there are bureaucracies, and they are … [Read more...]