Medicare Compliance for Clinical Laboratories (updated 2009) (Online Course)
Christopher Young
Based on the OIG Compliance Program Guidance for Clinical Laboratories, this course covers all elements of a successful Medicare compliance program. LMRPs, ABNs, coding, and requisitions are given full treatment. Special sections for billing departments, managers, and sales / marketing departments emphasize requirements specific for these areas. Ten case studies allow employees to practice their knowledge and get feedback. This course is ideal for bench laboratory workers, sales and clerical staff, but is appropriate for all laboratorians.
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Continuing Education Credits
Objectives
- Define "Voluntary Compliance Program," discuss the elements that should be included, and explain why it is important for the laboratory to implement the program.
- Identify the laws and regulations that are applicable to Medicare that affect laboratories.
- Identify compliance problems and issues.
- Explain each of these terms or processes that are related to Medicare reimbursements: Medical necessity; ICD9CM, CPT, and HCPCS coding; Advance Beneficiary Notice.
- State the responsibilities of laboratory administration, management, laboratory employees, and the billing department that relate to Medicare compliance.
Course Outline
Click on a link in the outline to view a sample page from this course.
- Voluntary Compliance Program
- Introduction
- Seven Elements of a Compliance Program
- Laws and Regulations
- Laws and Regulations Applicable to Medicare
- Compliance Issues
- Confidentiality
- Billing
- Inducements
- Marketing and record retention
- Inducements
- Phlebotomists and equipment in client offices
- Utilization and other regulations
- Couriers and referral tests
- Documentation
- Processes and issues related to Medicare Reimbursement
- Medical Necessity
- ABNs
- Advance Beneficiary Notice (ABN)
- Changes to ABN, Effective March 1, 2009
- Coding
- ICD-9CM coding
- HCPCS and CPT coding
- Test Ordering
- Orders
- Test Requisitions
- Issues Related to Test Ordering, Performance, and Resulting
- Written and verbal orders
- Ambiguous or Unclear Test Orders
- Tests
- Panels and profiles
- Physician notices and acknowledgements
- Responsibilities for Medicare Compliance
- Laboratory Administration's Responsibilities
- Management Personnel Responsibilities
- Management's Responsibilities for Preventing Allegations of Medicare Fraud and Abuse
- Employee's Responsibility
- Billing Department
- Laboratory Billing Department Communication With Physicians and Patients
- Advance Beneficiary Notices (ABNs) and the Billing Department
- Documentation
- Sales and Marketing
- Equipment, contracts, and pricing
- Excused charges and other inducements
- Client contracts
- Test pricing and antitrust
- Sales proposals and discounts
- Whistleblowers
- Conclusion
- Case Studies
- Case Study 1
- Case Study 2
- Case Study 3
- Case Study 4
- Case Study 5
- Case Study 6
- Case Study 7
- Case Study 8
- Case Study 9
Additional Information
General Course Information: This course is designed to train staff the basic concepts of Medicare Compliance for clinical laboratories. It is based on the OIG Compliance Program Guidance for Clinical Laboratories, and covers seven elements of a successful compliance program, risk areas, coding, ABNs, tests and panels, inducements, billing, and whistleblowers. It includes 10 real-life case studies which highlight pertinent issues.
Intended Audience: All clinical laboratory personnel.
Level of Instruction: Basic
Author Credentials: Christopher Young, of Laboratory Management Support Services, Phoenix, AZ, is an independent consultant, and nationally recognized speaker and expert currently specializing in compliance, sales and marketing, and customer service, as they pertain to clinical laboratories. He has extensive first-hand laboratory experience, in positions ranging from phlebotomist, to decision support coordinator, and in his consulting practice.
Medicare Compliance for Clinical Laboratories (updated 2009) Keywords
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