Labs In Court

Fort Worth Hospital Settles Upcoding Charges for $3.3 Million

Case: A compliance officer morphed into a whistleblower when hospital leaders ignored her warnings about widespread billing and coding abuses. Specifically, she sounded the alarm that the hospital was … [Read more...]

Brief Your CEO

Make Sure Lab Staff Know about New CMS Clarification of IDTF Billing Rules

If your lab or facility is an Independent Diagnostic Testing Facility (IDTF), you need to know and brief your C-Suite about the new Centers for Medicare & Medicaid Services (CMS) issued new … [Read more...]

Coding Alert

CMS Adds New PLA Oncology, ELISA, Reproductive Codes to HCPCS

CMS added seven new PLA codes to the HCPCS files, effective July 1, 2021, which will be contractor-priced based on local rates until they undergo the CLFS annual payment determination process for … [Read more...]

Billing & Coding

OIG Sounds the Alarm on Improper Billing of Lipid Panels & Direct HDL Tests

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...]

CPT Coding

AMA Creates New PLA Code 0247U for Sera Prognostics PreTRM Test

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...]


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...]


Urgent Care Centers Settle E/M Upcoding Charges for $2 Million

Case: The owners/operators of CareWell urgent care centers in Massachusetts and Rhode Island have agreed to shell out $2 million for improper coding of Evaluation and Management services. CPT code … [Read more...]


Laboratory Information Systems (LIS): What You Need To Know To Get Paid

By Sean McSweeney  bio Today, laboratory billing claims require more and more data to successfully get paid. One of the biggest reasons your claims may be getting denied is because you're not … [Read more...]


Billing & Coding: Myriad Genetics Pays $9.1 Million to Settle Claims of Falsely Billing Medicare for Hereditary Cancer Tests

In March 2018, Myriad Genetics got a piece of mail no lab provider ever wants to see in its inbox: an OIG subpoena asking for billing records in connection with "an investigation into possible false … [Read more...]


Tennessee Pain Doctor Faces Jail for Opioid Abuses, Medicare Fraud

Case: The doctor is facing 45 charges, including 22 counts of illegal distribution of a controlled substance for routinely prescribing oxycodone and other Schedule II drugs without examining and … [Read more...]