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 | GCR April 2007 (full PDF issue) |
| Kennedy introduces bill on lab-developed tests
NPI compliance deadline looming
CMS to allow extended use of old CMS-1500
Phase III Stark regulations may be delayed
Two versions of ABN may be combined into one
What’s next with Pod laboratories? See Perspectives 5
Illinois court upholds PC billings by pathologists
Medicaid HMO hit with additional $190 million penalty
OIG issues new ruling on transportation subsidy
News in brief
Full Article |
| Lab Industry Requests Delay on NPI Compliance |
| Concerned about the impact on clinical laboratories, groups representing labs are pressuring the Centers for Medicare & Medicaid Services (CMS) to delay the deadline for compliance with the National Provider Identifier (NPI) requirement.
Full Article |
| Government Looks to Increase Oversight of Laboratory-Developed Tests |
| In the latest indication that the federal government is moving toward increased oversight and regulation of laboratory-developed tests (LDTs), Sen. Edward Kennedy (D-MA) in March introduced legislation that would designate LDTs as medical devices subject to premarket review and approval by the Food and Drug Administration (FDA).
Full Article |
| Phase III Self-Referral Rule May Be Delayed |
| The third phase of the final rule implementing the Stark II prohibitions on physician self-referral may be delayed until March 2008, according to the Centers for Medicare and Medicaid Services (CMS).
Full Article |
| CMS Extends Deadline for Using Old Version of Provider Claims Form |
| The Centers for Medicare & Medicaid Services (CMS) is allowing certain providers to keep using a Medicare claim form past the intended April 1 expiration date due to problems with the new version of the CMS-1500 form.
Full Article |
| Two Versions of ABN May Be Combined Into One |
| Under a recent proposal by the Centers for Medicare & Medicaid Services (CMS), the two versions of the current Advance Beneficiary Notice (ABN) would be replaced by a new single version that clinical laboratories and other Medicare providers would be required to use.
Full Article |
| What’s Next With Pod Laboratories? |
| Last year, when it issued the Proposed Physician Fee Schedule (PFS) rule, the Centers for Medicare and Medicaid Services (CMS) introduced a new concept of particular importance to laboratories—the "pod" or "condo" laboratory. No one seems to quite know where the term originated, but its inclusion in the proposed PFS rule was a recognition by CMS of what many in the industry had long been saying: New ventures were increasingly being developed that allowed physicians to share in the revenues earned on their referrals for different types of diagnostic services.
Full Article |
| Illinois Court Upholds PC Billing by Pathologists |
| An Illinois court on March 6, 2007, dismissed a class action suit by a group of pathologists and others that alleged the practice of professional component billing to be unlawful, according to the College of American Pathologists (CAP).
Full Article |
| Medicaid HMO Hit With Additional $190 Million Penalty |
| A federal judge March 13 imposed civil penalties of more than $190 million against Amerigroup Illinois and Amerigroup Corp., raising the company’s total liability following its healthcare fraud conviction last fall to a record $334 million (United States ex rel. Tyson v. Amerigroup Illinois Inc., N.D. III, No. 92C6074, 3/13/07).
Full Article |
| Proposal to Subsidize Ambulance Costs Could Violate Kickback Rules, OIG Says |
| A hospital’s proposed arrangement to subsidize ambulance transportation costs for out-of-area patients could likely run afoul of the anti-kickback statute and violate the civil monetary penalties provisions, the Department of Health and Human Services Office of Inspector General (OIG) said in a March 14 advisory opinion (07-02).
Full Article |
| News in Brief (0704) |
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FCA Settlement: Raritan Bay Medical Center in New Jersey has agreed to pay the United States $7.5 million to resolve charges, made in three separate False Claims Act whistleblower actions, that the hospital defrauded Medicare, the Department of Justice announced March 15. The government said Raritan Bay deliberately inflated charges for inpatient and outpatient care, from January 1998 through August 2003, to make the cases appear more costly than they actually were and thus received…
Full Article |
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