CEO SUMMARY: Under a proposed rule for Medicare region J-11, a pathologist will no longer be able to use “reflex templates or pre-orders for special stains and/or IHC stains prior to review of the routine H&E.” While the proposed LCD is designed to target a relatively small number of pathologists who regularly overutilize special stains,
Tag: rac audit
CEO SUMMARY: For 2013, the big story was money—or, more accurately, less money for providers. This was not limited to clinical labs and pathology groups, but was equally true of hospitals and physicians. In THE DARK REPORT’S annual lookback at the year’s 10 most important stories for the lab industry, the main theme is that
WITHOUT QUESTION, CLINICAL LABS AND PATHOLOGY GROUPS will be confronted with tough challenges during 2014. Across the nation, lab executives and pathologists tell us that it is no longer “business as usual.”
What I find most interesting about the feedback pouring into our offices is that the Affordable Care Act is not a factor for labs,
CEO SUMMARY: For labs and all healthcare providers, the risk of an audit is growing because the number of auditors seeking overpayments is rising. In their efforts to eliminate waste and make the Medicare and state Medicaid programs more efficient, federal officials have introduced several different audit programs in recent years. A consultant who helps
STORIES ABOUT HOW PRIVATE MEDICARE AUDITORS are overreaching in their zeal to identify fraud have caught the attention of the U.S. Senate Finance Committee. It is asking providers to submit examples of overzealous RAC auditors.
For its part, the Clinical Laboratory Management Association (CLMA) is collecting examples of recovery audit contractor (RAC) auditors behaving badly when
CEO SUMMARY: For labs currently processing prostate biopsy cases with five or more cores and for those pathologists interpreting those cases, there is a lack of clarity about new Medicare policies. As one example, risk of an audit is significant because of recent guidance issued by one Medicare contractor. Another source of risk for labs
CEO SUMMARY: When Medicare’s National Correct Coding Initiative (NCCI) manual took effect on January 1, 2012, it contained a significant change in how prostate biopsy claims are to be coded. This change was widely overlooked by the pathology profession and even dismissed entirely for its ambiguity and inconsistency with previously published guidance on the subject.
CEO SUMMARY: How will pathology laboratories respond to the publication of revised policies in how laboratories should file Medicare Part B claims for prostate biopsies? Not only will there be a sharp drop in the reimbursement paid for a 12-core prostate biopsy, but labs may be at increased risk of a RAC audit, along with
YOU CAN CONSIDER THIS ISSUE OF THE DARK REPORT TO BE an early warning of the escalating effort by public and private payers to rein in the “soaring cost” of clinical laboratory testing and anatomic pathology services.
The intelligence briefings you will read on the following pages address important topics, specifically: 1) a new Medicare policy
CEO SUMMARY: Last summer, InCyte Pathology in Spokane, Washington, found itself facing demand letters from the recovery audit contractor (RAC) responsible for that region. The RAC auditor was questioning claims for technical component (TC) services and seeking repayment from InCyte Pathology. It took three months and plenty of dogged determination for the InCyte team to