TAG:

rac audit

Medicare Special Stain LCD May Hinder Pathology Workflow

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…

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2013’s Top Ten Lab Stories Point to Tougher Times

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…

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Charting Your Lab’s Course for 2014

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 Aff…

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More Medicare Auditors Are Targeting Clinical 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 severa…

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In Medicare Bull’s Eye: Lab Test Reimbursement

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 pag…

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Labs Have Questions about Prostate Biopsy Policy

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 increas…

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Changed Medicare Policy Adds to Regulatory Risk

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 it…

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Lawyer Advises on Risk Of Prostate Biopsy Audits

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 Me…

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CLMA Asks Labs for Examples of RAC Auditor Overreach

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 …

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How One Pathology Group Survived Its First RAC Audit

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 InCy…

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