Jul 18, 2016 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Operations, Laboratory Pathology, Laboratory Testing, Managed Care Contracts & Payer Reimbursement, Management & Operations
Analysis shows new rule requires data gathering effort that favors larger medical laboratories and thus threatens community labs that serve smaller towns and rural areas
When The Centers for Medicare and Medicaid Services (CMS) issued their Final Rule for lab test market price reporting under the Protecting Access to Medicare Act of 2014 (PAMA) last month, it put the clinical laboratory industry on a path that will have significant financial consequences for all labs, whether large or small. Some experts believe this will be the most disruptive event to the medical laboratory industry in the past 30 years.
By now, the story is well known among pathologists and clinical laboratory directors. That story comes from CMS, which issued the Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule—AKA the Clinical Laboratory Fee Schedule (CLFS)—that directly affects clinical labs. Under this Final Rule, published in the Federal Register, June 17, 2016, “laboratories and physician offices are required to report private payer rate and volume data if they have more than $12,500 in Medicare revenues from laboratory services on the CLFS and they receive more than 50% of their Medicare revenues from laboratory and physician services during a data collection period. Laboratories will collect private payer data from January 1, 2016 through June 30, 2016 and report it to CMS by March 31, 2017.
“The first data reporting period (that is, the period during which data from the collection period will be submitted to CMS) will be from January 1, 2017, through March 31, 2017. All subsequent data collection and reporting periods for CDLTs [Clinical Diagnostic Laboratory Tests], except for ADLTs [Advanced Diagnostic Laboratory Tests], will follow this same data collection and reporting schedule, every three years. Reporting of private payer rates for ADLTs will occur on the same schedule except it will be on an annual basis,” states the Final Rule. (more…)
Apr 11, 2014 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Digital Pathology, Instruments & Equipment, Laboratory Management and Operations, Laboratory News, Uncategorized
Although most clinical laboratories and pathology groups do not use EHR systems, the OIG’s finding should alert them to possible problems with audit integrity of their clients’ EHRs
Electronic Health Record (EHR) systems were supposed to prevent fraud, but a recent report from one federal agency states that the fraud safeguards built into EHR systems are not in engaged by a majority of users.
Pathologists and clinical laboratory managers with the responsibility to maintain security of software systems used in their medical laboratories may be interested to read “Not All Recommended Fraud Safeguards Have Been Implemented in Hospital EHR Technology,” a report issued by the Health and Human Services’ (HHS) Office of the Inspector General (OIG). (more…)
Feb 22, 2013 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Uncategorized
Issue does not directly affect clinical laboratories and pathology groups, but puts spotlight on some hospitals and physicians who frequently use these codes.
Could increased use of electronic health records (EHR) systems be causing more hospitals and physicians to commit fraud because of upcoding? That’s the assertion of certain federal health officials. They attribute the increased proportion of Medicare claims for more complex and more expensive services by some providers to be, in some part, acts of fraud.
Most pathologists and clinical laboratory managers will notice the irony in these allegations that providers are upcoding services to Medicare patients in fraudulent ways. After all, the federal government is currently paying billions of dollars in financial incentives to encourage providers to implement and use certified EHR systems with the goal of lowering healthcare costs, while improving patient outcomes.
OIG Audit Findings Are Source of Fraud Allegations
Insinuations of provider fraud came after the public learned of findings of an audit done by Health and Human Services’ Office of Inspector General (OIG). The OIG determined that payments for more complex Level 5 E/M services increased by 21% between 2001 and 2010. During that same period, payments for medium-complexity patient services decreased by 11%.
For all of 2010, the Centers for Medicare and Medicaid Services (CMS) paid out $33.5 billion for E/M billings. This was about one-third of Medicare Part B payments for physician services. These numbers were part of a story published in Modern Healthcare.
Now that much larger numbers of physicians and hospitals are using electronic health record (EHR) systems, Medicare has noticed a steady increase in the proportion of claims submitted at higher and more complex codes, increasing reimbursement. In response to one federal government audit, Kathleen Sebellius, Secretary of Health and Human Services (r) and Attorney General Eric Holder (l) held a joint press conference to announce to healthcare providers that there would be stricter audits of providers who are using billing codes for complex patient visits with greater frequency. (Photo by Manuel Balce Ceneta, copyright Associated Press.)
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Apr 1, 2011 | Laboratory News, Laboratory Pathology
That’s not news to pathologists, who often see how physicians mis-order or mis-interpret clinical laboratory tests
Each month, one out of seven Medicare patients is injured or killed by their healthcare providers. These medical errors cost taxpayers hundreds of millions of dollars each year. And, that doesn’t even include the cost of follow-up care for the injured patients who survive.
Those and other conclusions are part of a recently released study by the Department of Health and Human Services (HHS) Office of Inspector General (OIG) titled “Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries.”
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Oct 27, 2010 | Laboratory News, Laboratory Pathology, Uncategorized
Findings came after OIG audited the Healthcare Integrity and Protection Databank
Adverse actions taken by federal healthcare regulators against clinical pathology laboratories and other healthcare providers have not been reported to a public database as required by law. That is the finding of the Office of the Inspector General (OIG), based on its study of the information contained in the Healthcare Integrity and Protection Data Bank (HIPDB).
During its audit of the HIPDB, the OIG determined that the Centers for Medicare and Medicaid Service (CMS) failed to report disciplinary actions it took against medical laboratories and other providers to the Healthcare Integrity and Protection Data Bank (HIPDB). According to the OIG’s recently-released report, CMS’s Division of Laboratory Services was responsible for many of the omissions.
Clinical Laboratory Actions Should Be Listed in the HIPDB
The HIPDB is a national database of adverse actions taken by federal agencies against “healthcare practitioners, providers and suppliers,” who are defined in the OIG report as medical doctors, laboratories, clinics, nursing homes, managed care facilities, prescription drug plans and durable medical equipment (DME) suppliers.
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