decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Clinical Lab Services / Fraud alerts / Discounts on composite rate tests
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Article Overview
This article covers a Medicare fraud alert focused on end stage renal disease laboratory services and pricing arrangements between labs and ESRD facilities. It explains the general compliance concern, the role of Medicare payment structure for routine and additional testing, and how anti-kickback and discount safe harbor concepts are discussed in the alert. It is relevant to coders, compliance staff, lab administrators, and reimbursement professionals working with ESRD-related laboratory billing.
Why This Topic Matters
The article addresses a compliance risk area where lab pricing and referral relationships may trigger fraud-and-abuse concerns. Understanding the scope of the alert helps organizations recognize when ESRD lab billing arrangements may raise Medicare legal and payment issues.
What You Will Learn
- How Medicare payment for ESRD laboratory services is generally structured
- What type of lab arrangement the fraud alert discusses
- Why the arrangement is analyzed under anti-kickback and discount-related compliance concepts
- Which organizations and compliance topics are implicated by the alert
Who Should Read This
- Medical coders
- Compliance officers
- Laboratory administrators
- Billing staff
- Revenue cycle professionals
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