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medicare billing

OIG 2020 Plan of Work to Review Billing for Medicare Part B Tests

Since October, the federal Department of Health and Human Services Office of Inspector General (OIG) has published two versions of its plan of work for 2020. In both versions, the inspectors highlighted OIG’s efforts to review compliance with Medicare Part B billing requirements for clinical labora…

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Pathology Errors a Factor in 3 Deaths at VA Hospital

CEO SUMMARY: Outside pathologists are reviewing the pathology reports of almost 20,000 patients of an Arkansas Veterans Administration hospital following termination of a Chief of Pathology who was believed to have handled cases while impaired. Currently, the review identified 256 cases w…

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Attorney Explains 70/30 Rule, Pass-Through Bill Arrangements

HOW THE LAB OUTREACH BUSINESSES of rural hospitals originate lab specimens and bill for lab tests is getting increased scrutiny. The reason for this rise in interest is that a growing number of rural hospitals are generating almost as much revenue from laboratory outreach testing as they get from all…

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Wake Forest Baptist Lab’s Path Errors Teach Lessons

CEO SUMMARY: For medical directors and pathologists interested in improving their labs’ compliance with CLIA regulations, a report from federal and state inspectors of an inspection of the pathology lab at the Wake Forest Baptist Medical Center offers insights into what issues caught th…

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NC Hospital Reviewing Path Lab Deficiencies

CEO SUMMARY: Discovery of multiple diagnostic errors occurring in an anatomic pathology department triggered a complaint investigation and a 54-page report from the federal Centers for Medicare and Medicaid Services. The report shows that Wake Forest Baptist Medical Center is reviewing mo…

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Wake Forest Baptist Hospital Reviewing Path Lab Deficiencies

CEO SUMMARY: In response to information the staff provided to Wake Forest Baptist Hospital’s risk manager last fall, and following a federal Centers for Medicare and Medicaid Services inspection in February, CMS describes deficiencies found as “an immediate jeopardy to the health and …

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Finally, Abbott Buys Alere to Become #1 in POCT

CEO SUMMARY: After nearly two years of legal battles, Abbott Laboratories’ acquisition of Alere concluded on Oct. 3. Despite antitrust requirements to divest several of Alere’s diagnostic businesses to Quidel and Siemens Healthineers, the merger makes Abbott the world’s largest provider…

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Damon Laboratories, Mitt Romney, and Politics

IT IS SELDOM THAT THE CLINICAL LABORATORY INDUSTRY HITS THE RADAR SCREEN during a presidential election. So it is with some interest that I report to you that Mitt Romney recently touted the lessons he learned while serving on the board of Damon Clinical Laboratories, Inc., as useful…

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Independent Labs Won’t Get Medicare PQRI Bonuses

CEO SUMMARY: Medicare does not intend to make bonus payments this year to independent labs currently reporting quality information for breast and colon cancer cases. The federal claims payment system is unable to pay independent labs for participating in the federal physician quality repo…

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Michigan Derm Convicted On 31 Fraud Charges

CEO SUMMARY: Last year, dermatologist Robert W. Stokes, D.O., of Grand Rapids, Michigan, was indicted by the federal government for 72 counts relating to various offenses, including upcoding, and improper coding. Of this total, 35 counts against Stokes involved his billing payers for labo…

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