UTILIZATION MANAGEMENT

You Make the Call: Incentivizing MDs to Order More Early Screening Tests

A Managed Care Organization (MCO) wants to pay providers incentives to increase early and periodic screenings, diagnostic and treatment (EPSDT) services to Medicaid patients. Payments are capitated, … [Read more...]

Enforcement Trends: Opioid Crackdown Is Diverting Resources from Traditional OIG Enforcement Activities

The OIG won't admit it, but the opioid crackdown is diverting resources from traditional Medicare fraud and waste enforcement efforts. At least that's the most likely explanation for the dramatic … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: November 2018

This month, there were six new Work Plan items, two of which have implications for at least some labs. 1. CDC's Oversight of the President's Emergency Plan for AIDS Relief Funds Issue: Through the … [Read more...]

FEE SCHEDULES

Reimbursement Trends: Part B Medicare Lab Payments Up Slightly in 2017

According to a new OIG report, Clinical Laboratory Fee Schedule payments for lab tests in 2017, the last year under the pre-PAMA payment system, totaled $7.1 billion, up slightly from the $6.8 billion … [Read more...]

COMPLIANCE GUIDANCE

Kickbacks: OIG Okays Incentivizing MDs to Order More Early Screening Tests

Proactive rather than reactive has become a mantra of the modern health care model. Early and periodic testing of patients is a critical element in this strategy. The problem is that not a lot of … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: October 2018

October saw five new OIG Work Plan items. One has direct implications for labs, while two have potential implications for some labs. These three items are detailed below. 1. CMS Medicare Beneficiary … [Read more...]

CMS

Reimbursement Trends: OIG Report Shows Slight Uptick in 2017 Medicare Part B Lab Payments

On Jan. 1, 2018, the new Medicare Part B PAMA Clinical Laboratory Fee Schedule (CLFS) in which lab test reimbursements are based on a single national fee lab schedule for lab tests rather than 57 … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: September 2018

Neither of the two new OIG Work Plan items directly impacts labs but both address areas of national concern and have potential long-term implications on at least some labs. 1. Follow-Up Review of … [Read more...]

REIMBURSEMENT

PAMA: OIG Backing of CMS Heats Up Market-Based Lab Rates Controversy

CMS did it right and saved Medicare a boatload of money in the process, concludes a new OIG report reviewing the methods CMS used to establish "market-based" rates for Medicare Part B lab tests. Of … [Read more...]

FEE SCHEDULES

OIG Backs CMS on PAMA Market Rate Setting—and the Lab Industry Is None Too Pleased

CMS did it right and saved Medicare a boatload of money in the process, concludes a new OIG report examining the agency's work in carrying out its PAMA mandate of establishing market-based Medicare … [Read more...]


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