Laboratory Compliance
Perform a prospective or
retrospective review of a sample of laboratory claims to determine compliance
with Medicare and Third Party Payer regulations governing laboratory services. This
includes a review to assure accurate coding, CPT, HCPCS and ICD-9, complete
charge capture, appropriate “bundling” of services, documentary support for
services claimed, including physician order and performance of testing within
the laboratory’s CLIA certification. It also includes review to assure accurate
reporting of “POS” necessary for optimal reimbursement. The review also
includes a focus on diagnosis coding by laboratory personnel when narrative
diagnoses alone are submitted with physician orders.
A review of compliance with
Medicare’s ABN requirements is a
part of this engagement as is review of any “charge capture”
document(s)/requisitions utilized.
Review of a laboratory’s Policy & Procedure Manuals is
available as an add-on or stand alone engagement. This includes a review of
compliance in high risk areas including:
·
oral orders
·
add-on orders
·
“custom” profiles
·
“standing” orders
·
automated panels/medical necessity
·
Medicare’s “72 hour” rule
·
supplies provision to physician offices and/or
hospitals
·
record retention
·
blood borne pathogen program
·
RIA testing
·
·
“70% on
site test run”/”shell lab” issues
·
drug screening
·
pathology services
·
pap smears
·
“screening” tests
·
“reference lab”/ “referral lab” issue
·
specimen collection home/SNF
·
Medicare’s “physician supervision” issues
·
“purchased interpretation” issues
·
hazardous waste
A CLIA compliance review, including QC Regulations & Inspections, is available as an add-on or
stand alone engagement.
In laboratories performing RIA Testing, a review for compliance
with NRC regulations is available as
an add-on or stand alone engagement
“Documentation” and “Charge
Capture” Templates
Coding: “per diem” and “backlog” coding services are available by
AAPC certified coders
Our Coding Helpline to answer coding/billing questions on demand is
available with a 24 hour response time in most cases.
Compliance Plan design, implementation & training; focus is on
the OIG’s “Model Compliance Plan for Clinical
Laboratories”
A “Shadow Review” service for Third Party Payer “Medical Claim Reviews” is available as an add-on or stand alone
engagement.
Claim Denial, Suspend and
Reduction reviews are available as well as preparation of Re-submissions and Payer Appeals
HIPAA compliance reviews
Litigation Support in Medicare fraud/abuse actions
Stark Law compliance reviews are
Seminars on coding, documentation and billing laboratory services
are available for both clinical and
non-clinical staff
Billing seminars on Laboratory services
CLIA seminars for clinical and
non-clinical staff
“Update Seminars” are available; focusing on regulatory change
All seminars
are available on videotape
Additional services available