Laboratories: LAB UNBUNDLING SCRUTINY NEVER DIES

Subscribe or sign in to view the full article.

articles:   
Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

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

  • HCPCS Level II: 85021
  • HCPCS Level II: 85022
  • HCPCS Level II: 85023
  • HCPCS Level II: 85024
  • HCPCS Level II: 85025
  • HCPCS Level II: 85027
  • HCPCS Level II: 85595
  • HCPCS Level II: 81000
  • HCPCS Level II: 81001
  • HCPCS Level II: 81002
  • HCPCS Level II: 81003
  • HCPCS Level II: 81005
  • HCPCS Level II: 81015

Code Ranges Discussed

  • HCPCS Level II: 85021-85025
  • HCPCS Level II: 81000-81003

Subscribe or sign in to view the full article.

articles:   

Keep pace with evolving Medicare regulations — and onboard your team — with timely analysis of critical updates interpreted in an easy-to-follow, easy-to-apply format. Your subscription to TCI's Medicare Compliance & Reimbursement Alert will equip you to navigate code and guideline changes, CCI edits, and revisions to modifiers, payer policies, the fee schedule, OIG target areas, and more.

  • Current newsletters added each month
  • Fully searchable archives - over 4200 articles
  • ALL years/issues back to 2003 organized by year and issue
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information pages link back to related articles

This feature is currently unavailable for online purchase. For more information, please call 801-770-4203 or Contact Us.

demo
request yours today
 subscribe
start today
 newsletter
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.

Aimee- AI -powered coding assistant - Try it now for Free Would you like Aimee - AI
to help you with this?