Medicare Compliance for Clinical Laboratories
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.
Help meet laboratory safety and compliance requirements with this and other MediaLab courses. Subscriptions for your laboratory include unlimited access to Medicare Compliance for Clinical Laboratories and 43 other courses, plus MediaLab's powerful, easy-to-use learning management system for tracking and documenting laboratory compliance training. Individual subscriptions for laboratory continuing education are also available.
Continuing Education Credits
Objectives
- Understand the basic elements of a voluntary compliance program
- Determine their compliance role in the laboratory and be able to help prevent fraud and abuse from occurring in their laboratory
- Understand the consequences of violating the law and the compliance policies of the laboratory
- Recognize compliance problems and issues even when they are not a component of their direct role in the laboratory
- Understand why it is important for the laboratory to undertake a voluntary compliance program
Course Outline
Click on a link in the outline to view a sample page from this course.
- Introduction
- Introduction
- Seven Elements of a Compliance Program
- Laws and Regulations
- Laws and regulations that govern laboratories
- General
- Risk Areas
- Risk areas
- Billing and medical necessity
- Coding
- Coding
- Medical coverage policies (LMRPs)
- ABNs
- Advance Beneficiary Notices (ABNs)
- Confidentiality
- Test and Orders
- Orders
- Requisitions and ambiguous orders
- Tests performed and ordered correctly
- Written and verbal orders
- Tests
- Physician notices and acknowledgements
- Documentation and test release
- Panels and profiles
- Inducements
- Inducements
- Marketing and record retention
- Inducements
- Phlebotomists and equipment in client offices
- Utilization and other regulations
- Couriers and referral tests
- Billing
- Billing
- Coding
- ICD-9CM coding
- Local medical review policies (LMRPs)
- HCPCS and CPT coding
- Documentation
- Communication with physicians and patients
- Advance Beneficiary Notices (ABNs)
- Documentation
- Managers
- Special Roles
- Managers must set example
- Special role for managers/supervisors
- Whistleblowers
- Preventing whistleblowers
- Protecting the company
- Whistleblowers
- Sales and Marketing
- Equipment, contracts, and pricing
- Excused charges and other inducements
- Client contracts
- Test pricing and antitrust
- Sales proposals and discounts
- Equipment and space
- Communication and Confidentiality
- Test orders
- Confidentiality and inducements
- ICD-9 codes and ABNs
- Communicating with patients in person
- 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
- Case Study 10
- Responsibility
- Employee's Responsibility
- Company Responsibility
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 Keywords
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