National Intelligence Report
This biweekly newsletter provides concise, independent coverage and analysis of fast-breaking lab, pathology, blood banking, imaging and diagnostic radiology news from the Nation's Capital. You'll find out about: Medicare payment and policy directives Billing guidelines and coding changes for diagnostic facilities CLIA & MQSA regulatory mandates, changes and interpretations Congressional actions & legislative initiatives Federal compliance requirements OIG anti-fraud initiatives, Stark self-referral prohibitions, plus other legal news FDA oversight of in vitro diagnostics, blood banks, and radiological devices OSHA, NRC, and state safety standards.
August 13, 2008 - Table of Contents
The Centers for Medicare and Medicaid Services earlier this year announced plans to issue a revised Advance Beneficiary Notice (ABN) that clinical laboratories and other providers billing Medicare Part B must use by no later than Sept. 1. But since CMS has yet to release final instructions implementing the change, this deadline will not likely be met.
While Congress just enacted Medicare legislation canceling a physician fee cut and repealing lab competitive bidding, lawmakers have already been put on notice that physician and clinical laboratory groups will be pushing next year for fundamental changes in the methods that Medicare uses to pay for their services.
The Centers for Medicare and Medicaid Services has asked a federal district court in San Diego to dismiss the lawsuit filed by local labs to stop the agency from implementing the launch of a Medicare competitive bidding demonstration for independent clinical laboratory services. The court granted a preliminary injunction earlier this year blocking CMS from proceeding with the demo and gave the agency until Aug. 8 to respond.
Stamped physician signatures are not acceptable on any medical record, the Centers for Medicare and Medicaid Services has emphasized in new guidance to providers and Medicare contractors. CMS acted in response to problems of noncompliance with requirements for a valid physician signature on medical documents. The new guidance (Change Request 5971) prohibits use of stamped signatures. Medicare does accept handwritten or electronic signatures or facsimiles of the original written or electronic signatures.
Physicians and other Medicare providers will not risk administrative sanctions if they waive retroactive beneficiary cost sharing amounts attributable to increases in the Part B physician fee schedule payments enacted in the new Medicare law, the HHS Office of Inspector General said in a July 23 policy announcement.
Coming fast on the heels of the clinical laboratory industry’s victory in beating down the competitive bidding demonstration and securing a CPI update to Medicare fees in 2009 after a five-year freeze, legislation was unveiled in the House that calls for a radical change in the Part B lab reimbursement methodology.
The Centers for Medicare and Medicare Services has declined to expand the Medicare Part B colorectal cancer screening benefit to include coverage of PreGen-Plus™ , a commercially available screening DNA stool test, as an alternative to a screening colonoscopy or a screening flexible sigmoidoscopy.
On Aug. 25, Medicare will begin to implement its new national coverage decision (NCD) that expands coverage of prothrombin time monitoring for home anticoagulation management to encompass more beneficiaries on warfarin therapy.
The Centers for Medicare and Medicaid Services has put the finishing touches on new requirements that physicians who own physician organizations will be treated as "standing in the shoes" of those entities for purposes of complying with the Stark self-referral law. Under the ‘stand in the shoes’ analysis, physicians referring Medicare or Medicaid patients to an entity for clinical lab and other designated health services are considered to have the same compensation arrangements with the entity as the physician organization in which they have ownership interest.
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