CEO SUMMARY: Attorneys who advise pathologists and clinical laboratories on compliance issues say the number of audits from the government and third-party payers has increased sharply in recent years. In those audits, payers are looking for recoupment of overpayments. A lab’s failure to provide proper documentation during these audits can result in the need to pay sixand seven-figure amounts. Payers also are auditing out-of-network billing and patient balance billing.
What Labs Need to Do as Payers Audit More Claims
Both government and private health plans are aggressively auditing labs for multiple issues
- By Joseph Burns
- > From the Volume XXII NO. 7 - May 11, 2015 Issue
- Tags: aco, Anatomic pathology, anti kickback statute, clinical lab, clinical lab test, clinical lab testing, clinical lab tests, clinical laboratories, Clinical Laboratory, clinical laboratory test, clinical laboratory tests, clinical labs, cpt, cpt code, dark report, emr, genetic test, genetic testing, jane pine, jane pine wood, lab manager, lab managers, lab test, lab testing, lab tests, laboratories, laboratory test, laboratory tests, local coverage determination, medical lab, medical labs, medical records, Medicare, Medicare Administrative Contractor, molecular testing, pathologists, Pathology group, pathology groups, pathology lab, pathology labs, pathology practice, pathology service, pathology services, patient record, pharmacogenetic, pharmacogenetics, private payer, the dark report, the laboratory
