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.
Change request (CR) 10446 informs contractors about the 2018 codes that are both subject to, and excluded from clinical laboratory improvement amendments (CLIA) edits. The CR also includes the codes discontinued as of December 31, 2017. The article was revised February 9 to reflect an updated CR. That CR added G0475 as a code that is subject to CLIA edits effective, April 13, 2015 (see page seven in bold). All other information remains the same. [MM10446]
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. [MM10445]
View this article to find information about external breast prosthesis and supplies.
Provider specialty page on the CMS website.
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.
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.
There are no items in this section at this time.
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.