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.
First Coast is seeking information to establish a local payment amount for lab test codes 0035U–0061U and 0011M-0013M.
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.
October update for clinical laboratory fee schedule and services subject to reasonable charge payment
Change request 10875 releases the October 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 and pricing of new codes. [MM10875]
Change request (CR) 10819 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). There are 17 newly added waived complexity tests. [MM10819]
This article provides direction on claims that RTP due to a procedure/revenue code mismatch. [CR 9837, CR 10409]
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.
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