decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Diagnostic Tests / Fraud Alerts / Unbundling a blood test from an automated test and billing it separately
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Article Overview
This article summarizes a fraud alert aimed at clinical laboratory billing practices and the relationship between automated multi-channel testing and separately billed lab services. It is relevant to coders, compliance staff, laboratory managers, and payer integrity teams who need to understand the broad reimbursement and billing concerns raised by the alert. The piece focuses on the general nature of the billing pattern, the payer organizations involved, and the financial impact described in the alert.
Why This Topic Matters
It highlights a laboratory billing issue that attracted payer and anti-fraud attention and may affect compliance reviews, laboratory charge capture, and reimbursement auditing.
What You Will Learn
- The general billing concern described in the fraud alert
- How payer and anti-fraud organizations identified the issue
- Why laboratory billing patterns can trigger compliance review
- The kinds of financial impacts associated with the alert
Who Should Read This
- Medical coders
- Certified professional coders
- Clinical laboratory billing staff
- Compliance officers
- Revenue cycle staff
- Audit and integrity teams
Codes Discussed
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