decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
ESRD / Fraud alerts / Lab pricing at renal dialysis centers
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Article Overview
This premium article reviews a Medicare payment issue affecting ESRD dialysis settings, focusing on how laboratory testing is split between bundled facility payment and separately billed services. It discusses an OIG fraud alert, the compliance risks of pricing arrangements tied to referral volume, and the role of federal fraud-and-abuse guidance for labs, dialysis providers, and compliance staff.
Why This Topic Matters
The topic is important because billing and referral arrangements in dialysis-related laboratory services can create legal and compliance exposure under federal anti-kickback rules. It helps billing, compliance, and legal professionals recognize when pricing and referral relationships may raise concerns in Medicare-participating settings.
What You Will Learn
- How Medicare payment for ESRD-related laboratory testing is generally structured
- What types of pricing arrangements are discussed in the context of dialysis facilities and laboratories
- Why fraud alerts and federal fraud-and-abuse guidance matter for ESRD laboratory relationships
- Which compliance areas are relevant when evaluating bundled versus separately billed lab services
Who Should Read This
- Medical coders
- Billing specialists
- Compliance officers
- Revenue cycle staff
- Healthcare attorneys
- Dialysis facility administrators
- Laboratory billing teams
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