Change request (CR) 10586 provides the July update to the lists of codes that are subject to billing instructions associated with the Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived tests. [MM10586]
The CERT A/B MAC Outreach & Education Task Force published the guide, “Complying with documentation requirements for laboratory services” to educate laboratories and ordering/referring physicians on documentation requirements for laboratory services. Read more to learn about the improper payments for laboratory services identified by the Comprehensive Error Rate Testing (CERT) program due to documentation errors.
This article provides tips from First Coast to assist in preventing clinical laboratory test claim errors under the CERT program.
Some clinical laboratories in the U.S. Virgin Islands are charging patients prior to performing services, a potential assignment violation. The article outlines Medicare regulations and potential penalties applicable to laboratories.
Quarterly update for clinical laboratory fee schedule and services subject to reasonable charge payment
Change request 10445 releases the quarterly update to the clinical laboratory fee schedule (CLFS) and laboratory services subject to reasonable charge payment, which provides instructions for accessing the 2018 CLFS data file, pricing of new codes, deleted codes, and correction to existing code 80410. This article was revised March 15 to reflect an updated change request (CR). That CR removed the list of new codes with a QW modifier that were effective as of April 1, 2018, from the policy section. All other information remains the same. [MM10445]
Effective for claims with dates of service on and after July 1, 2012, pathologists and independent laboratories that provide the technical component of physician pathology services furnished to hospital patients may no longer bill for and receive Medicare payment for these services.
This article provides direction on claims that RTP due to a procedure/revenue code mismatch. [CR 9837, CR 10409]
This tutorial of the CMS.gov website CLIA page will demonstrate how to determine if a CPT code requires the QW modifier.
The Office of the Inspector General (OIG) and other federal agencies have emphasized the importance of voluntarily developed and implemented compliance plans. The OIG has supplied guidance as to the elements of a model compliance plan.
Provider specialty page on the CMS website.
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.