"Excellent course! I would recommend this course to anyone learning or refreshing their basic knowledge in hemostasis."

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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.

Continuing Education (CE) Credits

P.A.C.E. Contact Hours: 2 hour(s)
Florida CE: General: 1 hour(s)

Other Medicare Compliance Courses

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Medicare Compliance for Clinical Laboratories 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

Medicare Compliance for Clinical Laboratories Outline

Introduction

Introduction

What is a voluntary COMPLIANCE program?
Introduction

Seven Elements of a COMPLIANCE Program

Element 1
Element 2
Element 3
Element 4
Element 5
Element 6
Element 7

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

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

Medical necessity
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

Medicare Compliance for Clinical Laboratories Keywords

Click on a term below to see its use in this Medicare Compliance for Clinical Laboratories course and other available MediaLab courses.

laboratory (63 occurances)
compliance (37 occurances)
billing (29 occurances)
medicare (27 occurances)
physician (24 occurances)
manager (16 occurances)
procedures (15 occurances)
supervisor (13 occurances)
doctor (12 occurances)
codes (11 occurances)
code (11 occurances)
requisition (10 occurances)
cpt (8 occurances)
diagnosis (8 occurances)
health (6 occurances)
billed (6 occurances)
abn (6 occurances)
inducement (6 occurances)
disease (6 occurances)
icd-9 (6 occurances)
whistleblower (6 occurances)
training (5 occurances)
hospital (5 occurances)
coding (5 occurances)
icd-9cm (4 occurances)
insurance (4 occurances)
medicaid (4 occurances)
symptom (4 occurances)
phlebotomist (3 occurances)
lmrp (3 occurances)
antikickback (3 occurances)
beneficiaries (3 occurances)
clinical (3 occurances)
clinical laboratory (2 occurances)
blood (2 occurances)
budget (2 occurances)
chemistry (2 occurances)
compliance training (2 occurances)
confidentiality (2 occurances)
healthcare (2 occurances)
evaluation (2 occurances)
kickback (2 occurances)
identity (2 occurances)
corrective (2 occurances)
nursing (2 occurances)
osha (2 occurances)
samples (2 occurances)
treatment (2 occurances)
waste (2 occurances)