General Surgery Coding Alert - 2018 Issue 7
Compliance: Part B Lab Tests Remain a Fixture on the OIG Hit List
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Article Overview
This article covers Medicare Part B laboratory testing compliance from a broad policy and enforcement perspective. It discusses improper payment monitoring, OIG work plan attention, recent Medicare payment and fee schedule changes affecting lab services, and the continuing focus on false claims and kickback concerns. It is relevant to compliance professionals, billing and coding staff, laboratory administrators, physicians, and other stakeholders who follow Medicare lab reimbursement oversight.
Why This Topic Matters
Laboratory services are a major area of Medicare spending and federal oversight. Understanding the compliance environment helps organizations track reimbursement trends, monitor risk areas, and stay aware of federal enforcement priorities affecting clinical diagnostic testing.
Article Sections
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Background
Introduces the article’s focus on Medicare lab test payment oversight and the broader compliance environment. It frames the discussion around improper payment monitoring and federal attention to lab-related claims risk.
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Consider These Recent Stats
Summarizes recent Medicare payment and improper payment data for laboratory testing. It also places lab spending and fee schedule changes in the context of federal oversight and potential enforcement interest.
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Bad news
Discusses concerns that Medicare payment reductions may affect access to testing and laboratory operations. It presents the general compliance and operational implications without detailing specific coding rules.
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Result
Describes the addition of a lab-related item to the OIG Work Plan and the continued focus on monitoring Medicare payments. It highlights federal interest in oversight of clinical diagnostic laboratory tests.
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Warning
Addresses enforcement concerns involving fraudulent claims and improper financial relationships in the laboratory space. It emphasizes the ongoing role of federal agencies in investigating and penalizing misconduct.
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Resource
Lists external references for further background on Medicare laboratory payment policy and related federal reports. It serves as a source list rather than substantive guidance.
What You Will Learn
- The federal compliance and enforcement issues affecting Medicare Part B laboratory testing
- How improper payment monitoring relates to clinical diagnostic laboratory services
- Why recent Medicare payment changes are relevant to laboratories and providers
- What kinds of broad fraud and abuse concerns are associated with lab work
- Which federal agencies and reports are discussed in connection with lab oversight
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Laboratory administrators
- Physicians
- Revenue cycle professionals
- Healthcare auditors
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