The Eliminating Kickbacks in Recovery Act (EKRA), a law that became effective in October 2018, extended federal kickback prohibitions to services provided by recovery homes, clinical treatment facilities, and laboratories...more
A dispute between a clinical laboratory and a former employee who had managed the lab's client accounts has resulted in an unanticipated interpretation of the Eliminating Kickbacks in Recovery Act (EKRA). Background -...more
CMS recently published a proposed rule that would substantially revise the methodology used to pay for clinical laboratory tests that continue to be compensated separately by Medicare. Medicare Program; Medicare Clinical...more
10/20/2015
/ Centers for Medicare & Medicaid Services (CMS) ,
Clinical Laboratories ,
Clinical Laboratory Testing ,
Medicaid ,
Medicare ,
Medicare Advantage ,
Medicare Part A ,
Medicare Part B ,
Medicare Part C ,
Medicare Part D ,
PAMA ,
Payment Methods ,
Payment Rates ,
Reporting Requirements
Labs Attempt to Counter Exclusive Lab Arrangements -
With increasing frequency, clinical laboratories have found themselves unable to receive any payments for tests performed for individuals whose third-party insurer...more
In Int’l Rehab. Sci. v. Burwell, No. 08-cv-05442 (W.D. Wash. Feb. 13, 2015), the court found inadequate an advance beneficiary notice (ABN) which stated that “Medicare has not established coverage criteria... or does not...more
There has been question for some time whether in evaluating certain discount arrangements involving clinical laboratory tests under the federal antikickback statute (FAS), discount charges should be measured against the...more
In previous Payment Matters articles, we described a policy included in the 2014 hospital outpatient prospective payment system (OPPS) final rule that would “package” certain clinical laboratory tests into OPPS, and CMS...more
In a previous Payment Matters article, we described a new CMS policy under which, effective January 1, 2014, hospitals would no longer be permitted to bill Medicare separately for clinical laboratory tests for hospital...more
Hospitals Lose Right to Bill Separately for Laboratory Tests for Outpatients -
As part of its calendar year 2014 hospital outpatient prospective payment system (OPPS) policy changes, the Centers for Medicare & Medicaid...more
Hospitals, laboratories, and other health care providers that rely on referrals from other health professionals may encounter situations where competitors have entered into arrangements with physicians or other referral...more
Much has been written regarding various Medicare policies that may cause a clinical laboratory to suffer the resulting financial consequences when a test requested by a physician is found to be not medically necessary, most...more
The Centers for Medicare & Medicaid Services (CMS) recently amended Medicare Claims Processing Manual (MCPM) provisions related to payment for anatomic pathology services to specifically address submission of such claims on a...more
District Court Finds That Medical Group’s Failure to Further Investigate Audit Results May Violate Requirement to Return Overpayments -
Background -
Internal audits of third-party payment claims – frequently...more
In a previous Payment Matters article, we reported that CMS had proposed to retract its rule requiring a physician or qualified non-physician practitioner (NPP) to sign the requisition for a clinical diagnostic laboratory...more
11/30/2011
In a previous Payment Matters article, we reported that CMS had instructed its Medicare contractors not to enforce the requirement that it had included in the Medicare Physician Fee Schedule Rule (MPFS) for calendar year...more
7/18/2011
As part of the Medicare Physician Fee Schedule final rule for calendar year 2011, the Centers for Medicare & Medicaid Services (CMS) required a physician or a qualified non-physician practitioner (NPP) to sign the requisition...more
5/4/2011
Q: Our laboratory is considering offering physicians the opportunity to request tests and receive test results electronically. What are some of the important regulatory issues we should consider?
A: Any such arrangement...more
3/18/2011
In our June 12, 2009 Payment Matters, we commented on a recent change in the Medicare Claims Processing Manual (MCPM) that would require claims for physician pathology services to be billed as separate line items if the two...more
A recent revision to the Medicare Program Integrity Manual (MPIM) states that physicians and non-physician practitioners may reassign benefits to an ambulatory surgical center (ASC), if the arrangement complies with a...more
CMS revised Medicare billing rules for diagnostic tests as part of its CY 2009 Physician Fee Schedule. These changes modified earlier changes made in the CY 2008 Physician Fee Schedule. Ober|Kaler's Robert E. Mazer and Mark...more
1/8/2009