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Clinical Labs Center

  • Ordering and Referring Denial Edits Will Turn on May 1, 2013

    Effective May 1, 2013, CMS will instruct contractors to turn on Phase 2 denial edits on the following claims to check for a valid individual National Provider Identifier (NPI) and to deny the claim when this information is missing
    • Medicare Part B claims including Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider; and
    • Part A Home Health Agency (HHA) claims that require an attending physician provider.

    For more information:

    Attend the National Provider Call on March 20 from 3-4:30ET. Register Now.

     

  • New and Reconsidered Clinical Laboratory Fee Schedule (CLFS) Test Codes and Preliminary Payment Determinations for Calendar Year 2013
  • New and Reconsidered Clinical Laboratory Fee Schedule Test Codes and Final Payment Determinations
  • The CLIA Brochure [PDF, 455KB] is designed to provide education on CLIA test methods categorized, enrollment In the CLIA program, types of certificates, certificate compliance and performance measures, and certificate of accreditation.
  • Extension of Reasonable Cost Payment for Clinical Lab Tests Performed by Hospitals with Fewer than 50 Beds in Qualified Rural Areas - On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA). Section 3122 of the PPACA re-institutes reasonable cost payment for clinical lab tests performed by hospitals with fewer than 50 beds in qualified rural areas as part of their outpatient services for cost reporting periods beginning on or after July 1, 2010, through June 30, 2011. This could affect services performed as late as June 30, 2012.  If you are a hospital who qualifies under Section 3122, you do not need to take any action. You will receive reasonable cost reimbursement for an entire year, starting with your cost reporting period beginning on or after July 1, 2010.  Please be on the alert for more information pertaining to the PPACA.

  • Medicare FFS e-News Spotlights

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