Medicaid Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Medicaid and links to relevant pages within the course.
Learn more about laboratory continuing education for medical technologists to earn CE credit for AMT, ASCP, NCA, and state license renewal and recertification. Or get information about laboratory safety and compliance courses that deliver cost-effective OSHA safety training and continuing education to your laboratory's employees.
| Which one of the following does not directly regulate clinical laboratories: | View Page |
| Element 5 Element 5:
Every employee must understand that the standards, policies and procedures associated with the compliance program must be adhered to at all times.
Employee will be disciplined up to terminations for violations.
Employee can be disciplined or terminated for failing to report a problem or suspect activity.
All employees are screened prior to being hired for previous actions against them by any law enforcement or government agency regarding any health care prosecution or exclusion from the Medicare or Medicaid program.
Adherence to the compliance program's policies and procedures will be a component of every employees annual evaluation and performance review.
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| Laws and regulations that govern laboratories Social Security Act:
Medicare and Medicaid laws are in this act.
Medicare rules and regulations come under this act.
Antikickback laws:
Provide criminal penalties for individuals or entities that knowingly and willfully offer, pay, solicit or receive money or favors for referrals of tests or services that will be paid for by the Medicare or Medicaid programs.
False Claims Act:
Provides criminal penalties for knowingly or willingly filing a false claim to a government program.
Self Referral (Stark) laws and regulations:
Identify financial relationships that have the potential to result in directed referral to one or both of the individuals or entities involved.
Prohibit the referral of patients or tests between related entities unless certain conditions are met.
Health Insurance Portability and Accountability Act (HIPAA)
Prohibits health care providers and payers from improper or inappropriate use of a patient's confidential health information
Requires health care providers to insure that a patient's confidential information is kept secure
Provides for standardized electronic formats for all health care transactions
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| Couriers and referral tests The laboratory's couriers may not transport items except those related to the testing services offered by the laboratory.
Couriers must follow all OSHA standards for the handling and transport of specimens.
The laboratory is responsible for all tests it refers to other laboratories.
Laboratory should not change CPT codes supplied by a reference laboratory without contacting the reference laboratory.
The laboratory is responsible for all tests it bills to Medicare/Medicaid even if the test was performed by a reference laboratory.
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| Client contracts A laboratory that receives referrals from a nursing home or Skilled Nursing Facility (SNF) should have a written agreement with that facility:
The Agreement should define billing and documentation responsibilities.
The facility should be responsible for determining the payment status of its patients and is liable for submitting incorrect payment information to the laboratory.
Fees should be consistent with other similar customers.
A laboratory that provides services to a Home Health Agency treating Medicare/Medicaid beneficiaries should have a written agreement with that agency:
The Agreement should define billing and documentation responsibilities.
The Agreement should place the responsibility on the Home Health Agency to establish that all patients receiving laboratory services are "homebound" as defined by Medicare.
Fees should be consistent with other similar customers.
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| What is Non-waived Testing? In 2003, the Center for Disease Control and Prevention and the Center for Medicare and Medicaid Services published the Clinical Laboratory Improvement Amendment (CLIA).Under CLIA, the term "Non-waived" replaces the terms “Moderate” and “High Complexity” testing. Before a laboratory can report patient results for a non-waived, FDA-approved test for the first time, the laboratory must verify that the test’s performance is similar to the manufacturer’s claims for accuracy, precision, and reportable range.
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