ED Coding & Reimbursement Alert - 2003 Issue 18
Laboratories: LAB UNBUNDLING SCRUTINY NEVER DIES
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Article Overview
This article covers a federal False Claims Act case involving alleged laboratory billing problems at a hospital, with attention to how prior Medicaid audit findings related to later Medicare scrutiny. It is relevant to laboratory billing, compliance, and health care fraud enforcement professionals who monitor claim integrity and outpatient lab reimbursement practices.
Why This Topic Matters
Laboratory claims remain a frequent target for enforcement actions, and this article highlights why payers and providers watch for billing compliance issues in outpatient laboratory services. It is useful for understanding the kinds of claim patterns that can attract scrutiny and the importance of internal compliance controls.
What You Will Learn
- How laboratory billing can become the subject of fraud enforcement review.
- Why prior audit findings may be relevant to later payer scrutiny.
- What broad compliance areas are emphasized for outpatient lab services.
- How Medicare and Medicaid claim issues can intersect in enforcement matters.
Who Should Read This
- Laboratory administrators
- Medical coders and billers
- Revenue cycle staff
- Compliance officers
- Health care attorneys
- Fraud and abuse investigators
Codes Discussed
Code Ranges Discussed
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