This article is for clinical laboratories who submit claims for services paid under the Medicare Part B clinical laboratory fee schedule (CLFS) to Medicare administrative contractors (MACs) for services furnished to Medicare beneficiaries. This article was revised January 8, 2020, to note that for CDLTs that are not ADLTs, the data reporting is delayed by one year and must now be reported from January - March 2021 (previously January - March 2020). All references to the 2020 data reporting period have been changed to 2021. The “CLFS Data Reporting Period Delayed” section was revised to summarize the changes. All other information remains the same. [SE19006]
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.
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.
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.
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