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. [MM10446]
Change request (CR) 10418 describes the latest tests approved by the Food and Drug Administration (FDA) as waived tests under with the Clinical Laboratory Improvement Amendments of 1988 (CLIA). The Current Procedural Terminology (CPT) codes for the new tests must have the modifier QW to be recognized as a waived test. [MM10418]
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.
Change request 10409 releases the annual 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, mapping for new codes, and updates for laboratory costs subject to the reasonable charge payment. [MM10409]
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.
This tutorial of the CMS.gov website CLIA page will demonstrate how to determine if a CPT code requires the QW modifier.
Provider specialty page on the CMS website.
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