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
September 29, 2021
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
July 28, 2021
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
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...]
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...]
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
Urgent Care Centers Settle E/M Upcoding Charges for $2 Million
November 28, 2019
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...]
CO-ORDINATING DATA
Laboratory Information Systems (LIS): What You Need To Know To Get Paid
September 30, 2019
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...]
WHISTLEBLOWERS
Billing & Coding: Myriad Genetics Pays $9.1 Million to Settle Claims of Falsely Billing Medicare for Hereditary Cancer Tests
July 30, 2019
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...]
CODING
Tennessee Pain Doctor Faces Jail for Opioid Abuses, Medicare Fraud
May 15, 2019
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...]
