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CodeMap® 12/16/2016: Annual Compliance Audits CodeMap®-12/16/2016: Annual Compliance Audits Archive

CodeMap® Compliance Briefing: December 16, 2016


Editor's Welcome:

Many of you have probably already read about embattled laboratories HDL and Millennium Health. Recently, these two organizations settled with the United States Department of Justice for $47 million and $256 million dollars respectively for allegations of paying kickbacks and submitting false claims. Most likely, both organizations could have prevented, or at least significantly mitigated, these massive payments if they had performed regular and effective compliance audits.

Today's CodeMap® Compliance Briefing will discuss the annual compliance audit, perhaps one of the most time consuming, and often scrutinized aspects of an effective compliance program. Absolutely no compliance program will be considered effective and fully provide its organization with the resultant protections without thorough documentation of ongoing annual audits. Considering the heightened enforcement environment that now exists, now is not the time for clinical laboratories to forget about this essential component of their compliance programs. As always, please forward any questions, comments, and/or suggestions to us via email.

Sincerely,

Gregory Root, Esq.


Annual Compliance Audits

by: Gregory Root, Esq.

gbroot@codemap.com

Introduction

As the end of the calendar year approaches, many provider organizations are planning and budgeting for the upcoming year. Those plans and budgets should include effective management of the organization's compliance program, including the performance of an annual compliance audit. Annual compliance audits are one of the most important aspects of a compliance program for many reasons. The most important reasons include the early identification of potential problems before they become major liabilities, and a clear demonstration that the organization continues to maintain an effective program.

OIG compliance guidance recommends that laboratories perform an annual compliance audit that includes an assessment of all operations, policies, and procedures to ensure compliance with the laws, rules, and regulations that govern participation in federally funded health care programs. Annual compliance audits should also assess the efficacy of the organization’s compliance program. Every set of compliance program guidance published by the OIG includes a thorough discussion of annual compliance audits. The following statement by the OIG demonstrates the importance of these reviews:

"An effective compliance program should also incorporate periodic (at least annual) reviews of whether the program’s compliance elements have been satisfied, e.g., whether there has been appropriate; (1) dissemination of the program’s standards; (2) training; (3) ongoing educational programs; and (4) disciplinary actions, among others. This process will verify actual conformance with the compliance program. The review also should look into whether appropriate records have been created and maintained to document the implementation of an effective program." The OIG's Compliance Program Guidance for Clinical Laboratories (August 1998).

The OIG reiterated its position in 2005 when the agency published supplemental compliance guidance for hospitals. In that guidance the OIG included an extensive set of considerations that hospitals must take into account when planning and performing annual compliance audits.

Finally, almost without exception, the OIG includes the requirement of an annual compliance audit in its corporate integrity agreements and settlements it executes with provider organizations. The OIG clearly considers the annual compliance audit an integral component of any effective compliance program. In fact, often the OIG's first consideration when determining whether an organization's compliance program is effective or not, is evidence and documentation of annual compliance reviews.

Scope of Annual Compliance Audits

The OIG's compliance guidance concerning clinical laboratories states the following considering the scope of annual compliance audits:

"At a minimum, these audits should be designed to address the clinical laboratory’s compliance with laws governing kickback arrangements, the physician self-referral prohibition, CPT/HCPCS coding and billing, ICD–9 coding, claim development and submission, reimbursement, marketing, reporting and record keeping."

In addition, the OIG recommends that the annual compliance audit also examines the organization's compliance with recently enacted, enforced, or revised laws, rules, and regulations. This recommendation will require organizations to review their compliance with the following, just to name a few:

  • state/federal provisions concerning the waiver of patient copays
  • anti-mark-up provisions for purchased diagnostic tests
  • direct billing rules, compliance with both federal and state provisions
  • developing coding, reimbursement, and coverage rules concerning molecular pathology procedures, drug/toxicology testing, and other developing technologies
  • issues identified by RAC/CERT investigations
  • PAMA reporting requirements

Finally, the annual compliance audit must include a thorough examination of the organization's compliance program including:

  • Screening of employees
  • Screening and registering of referring customers
  • Compliance policy manuals
  • Dissemination of compliance policies and standards
  • Compliance training for employees
  • Disciplinary actions
  • All ongoing or concluded investigations
  • Ongoing auditing and monitoring
  • Any interactions with federal and/or state agencies/regulators/investigators/contractors
  • Compliance committee/officer functions and organization
  • Documentation of compliance program activities

Other Important Considerations: Providers may choose from an array of auditing tools and techniques including on-site interviews, questionnaires, claims reviews, data-mining, chargemaster reviews, transactional analyses, and document review. We believe that personnel interviews are an important first step in any annual compliance review that will help determine the need for further types of analyses and investigations. The organization's personnel are usually the best source of information, and most auditors will quickly discover the few key individuals that truly run and understand the organization. When conducting interviews, auditors must ensure they speak to a wide array of personnel that control key compliance areas including management, coding, billing, sales/marketing, customer service, order processing, and information technology.

Internal vs. External Auditors: The OIG's compliance guidance for clinical laboratories states that compliance audits should be performed by "internal or external auditors who have expertise in federal and state health care statutes, regulations and the program requirements of federal, state, and private insurers." While we agree that auditors must possess certain expertise, we feel external auditors offer many advantages over internal auditors. These advantages include objectivity, specialized knowledge and expertise, and extensive experience in performing compliance audits.

Documentation: The final, and one of the most important, components of an annual compliance audit is documentation. The provider organization must maintain thorough documentation of its annual audits including methods, activities, findings, recommendations, and remedial or corrective measures. The best way to ensure your organization maintains this critical documentation is to require either internal or external auditors to conclude the annual compliance audit with the presentation of a comprehensive final report.


The 2017 CodeMap® Laboratory Complete Package includes 3 Manuals that will answer all your Medicare coding, reimbursement, and coverage questions. 

 
CodeMap has grouped three of its best-selling manuals and a subscription to its email compliance newsletter into one low-priced package. The 2017 CodeMap® Laboratory Complete Package allows laboratory and pathology providers to save big on the following CodeMap compliance tools:
 
The 2017 CodeMap® Reimbursement Manual for Lab and Pathology consists of detailed tables of all lab and pathology procedures, listed in an easy-to-use, all-on-one-page format, which organizes similar codes in logical groups for easy comparison and selection of codes. This is the only coding manual available that links CPT codes, ICD-10 codes, and Medicare reimbursement amounts, customized to your location, all on one page.
 
The 2017 CodeMap® Medicare Medical Necessity Guide for Lab and Pathology contains coverage policy information from BOTH NCDs and LCDs. The 2017 Guide is organized by test and includes the following information customized to your location: test name, CPT code, covered ICD-10 codes, and frequency limitations.
 
The 2017 CodeMap® CCI Guide for Lab and Pathology is a concise and easy-to-use guide that will help you understand and comply with CCI and MUE edits.
 
The CodeMap® Compliance Briefing is our email newsletter that provides important insight into coding, reimbursement, and compliance issues to over 11,000 subscribers.
 
SAVE $500: If you purchase the 2017 CodeMap® Laboratory Complete Package, you will save your organization $500. If you purchased these manuals and the email newsletter individually, the total cost would be $1,395.

3 easy ways to contact us and order your 2017 CodeMap Medicare Manuals:

1. Internet: Click here to order your 2017 CodeMap Medicare Manuals from our website;

2. Phone: Call us at 847-381-5465 to place your order. We accept credit cards and purchase orders;

3. Fax: Click here to download an order form. Then fill it out and fax it to us at 847-381-4606.


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02/10/2017: New Coding Options under PAMA
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01/12/2017: 2017 Clinical Lab Fee Schedule Update
12/21/2016: G0452 Settlements
12/16/2016: Annual Compliance Audits
11/11/2016: OIG Report on Lab Payments
11/03/2016: 2017 ICD-10 Codes and NCDs
10/27/2016: Custom Panels
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10/30/2015: Providing Meals to Physicians
10/09/2015: Update on Lab Tests for Colorectal Cancer Screening
09/30/2015: New Drug Testing Codes for 2016
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08/07/2015: DNA Based Infectious Disease Assays
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07/15/2015: FAQs Concerning ICD-10, 2016 Reimbursement, and CodeMap®
06/26/2015: Latest OIG Fraud Alert
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04/30/2015: Recent Enforcement Actions
04/23/2015: -59 Modifier Use and Changes
03/12/2015: Coding Waived Tests
02/5/2015: Providing Computer Equipment
01/15/2015: New Frequency Limits for Lab Tests
12/03/2014: CMS Issues New Drug Testing Codes
10/30/2014: Advisory Panel
10/13/2014: Preliminary 2015 Lab Fees
10/02/2014: Sales and Marketing Expenses
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05/30/2014: Dialysis Access Maintenance Coding
05/22/2014: Discounts to Financially Needy Patients
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04/30/2014: Discounts to Financially Needy Patients
04/02/2014: New 2015 CPT Codes, Part 2: Quantitative Drug Determinations
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02/13/2014: HIPAA Notice of Privacy Practices
02/06/2014: Patient Access to Laboratory Results
01/31/2014: Date of Service and the PC
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11/20/2013: Fraud and Abuse Enforcement
11/1/2013: Proposed Medicare Reimbursement for New 2014 Lab Codes
10/24/2013: Urinary Systems Procedures, Part 2
10/11/2013: New Molecular Pathology Fees
09/25/2013: Urinary Systems Procedures
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09/06/2013: Medicare Coverage Edits Part 3
08/21/2013: Medicare Coverage Edits Part 2
08/14/2013: Documentation for Complex Procedures
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08/09/2013: Coding for Thrombolysis and Thrombectomy, Part 2
08/09/2013: Physicians Payments Sunshine Act
07/26/2013: Coding for Thrombolysis and Thrombectomy, Part 1
07/26/2013: CMS Proposes Changes to Payment for Lab Tests: Part II
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06/27/2013: HIPAA and Patient Requests for Test Results
06/26/2013: Medicare Audit Improvement Act of 2012
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06/07/2013: CMS Publishes Initial Gap fill Fees for MoPath Tests
05/16/2013: OIG Special Advisory Bulletin Concerning Exclusions
05/03/2013: EMR and EHR Safe Harbor Proposals
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04/03/2013: Medicare Coverage of Preventive Care, Part 2
03/27/2013: Medicare Coverage of Preventive Care
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12/18/2012: Update to 2013 Lab Fee Schedule
12/13/2012: Apparent Errors in 2013 Lab Fee Schedule
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11/30/2012: Coding HLA Typing Tests
11/09/2012: 2013 Physician Fee Schedule Final Rule
10/18/2012: 2013 Radiology Coding Update, Part 2
10/16/2012: Stark Prohibitions and Non-Monetary Compensation
10/11/2012: Coding and Reimbursement for Calculated Lab Results
10/04/2012: 2013 Radiology Coding Update, Part 1
09/19/2012: CMS to Gap-Fill Molecular Pathology Codes
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08/29/12: To Code or Not to Code
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08/15/2012: Compliance Issues Related to Test Ordering Systems
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08/08/2012: Preparing for ICD-10
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08/2/2012: Future Directions: Medicare Compliance Enforcement
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07/25/2012: Waiving Patient Copays
07/20/12: Correct Use of Modifier -59 for Radiology Procedures, Part 2
07/12/12: Correct Use of Modifier -59 for Radiology Procedures, Part 1
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06/01/12: Specimen Collection Supplies
05/22/2012: Recent Enforcement Actions
05/22/2012: Recent Enforcement Actions
05/04/2012: Frequency Limits (MUEs) for Pathology Services
05/04/12: Diagnosis Coding for Diagnostic Radiology, Part 2
04/25/12: Diagnosis Coding for Diagnostic Radiology, Part 1
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03/30/2012: Coding for Drug Determinations, Part 1
03/21/12: Fluoroscopy Coding Revisited, Part 2
03/16/2012: Multianalyte Assays with Algorithmic Analysis (MAAAs)
03/14/12: Fluoroscopy Coding Revisited, Part 1
03/02/2012: Medicare Coverage for STD Screening Tests
02/14/2012: 2012 OIG Work Plan
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01/13/2012: 2012 Coding Update
2012 Publications Notification
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12/19/2011: Questions for 2012
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12/07/2011: Revascularization Coding FAQs
12/02/2011: Compliance Policies
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10/28/2011: Dialysis Access Maintenance Coding 2
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10/12/2011: Dialysis Access Maintenance Coding 1
10/7/2011: Palmetto LCD for Molecular Diagnostic Tests
9/26/2011: Proposed Payment for New CPT Codes
9/09/2011: New CPT Codes for 2012
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9/2/2011: Evaluation and Management Services
8/17/2011: Discounts to Financially Needy Patients
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8/12/2011: Annual Physician Notices
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04/01/2011: Genetic Testing Demonstration
2/25/2011: Medicare Drug Screening Update
2/11/2011: Recent OIG and DOJ Activity
2/4/2011: Medicare Annual Wellness Visit (AWV)
01/21/2011: Stark Self-Referral Prohibitions 3
01/14/2011: Stark Self-Referral Prohibitions 2
01/07/2011: Stark Self-Referral Prohibitions 1
2011 Publications Notice
12/17/2010: New, Revised and Deleted Radiology Codes
12/17/2010: Year-End Changes
12/10/2010: 2011 Medicare Lab Fee Schedule
11/19/2010: Coding and Reimbursement of Automated Tests
11/12/2010: 2011 OIG Work Plan
10/29/2010: Proposed Medicare Payments for new 2011 Lab Codes
10/12/2010: Medicare Provider Anti-Fraud Rule: Screening Tools
10/04/2010: Medicare Provider Anti-Fraud Rule: Risk Classification
09/17/2010: 2011 CPT Code Changes
09/03/2010: Conversion to ICD-10 Stays On Schedule
08/23/2010: Chromatography CPT Codes
08/23/2010 The Medicare Physician Fee Schedule
08/06/2010: Reimbursement Review
07/23/2010: Coding Review
07/16/2010: Supervision Requirements
07/08/2010: Employee Screening
07/01/2010: Signature Requirements for Test Requisitions and Orders
06/25/2010: Employee Screening
06/18/2010: Coding Quantitative Drug Tests
06/05/2010: 2011 Laboratory CPT and HCPCS Codes
05/21/2010: Timely Submission of Medicare Claims
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05/07/2010: New HIV Screening Codes
04/23/2010: E/M Coding and Breast Procedures
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04/16/2010: RAC Audits Part 2
04/09/2010: Update: Healthcare Reform and Laboratories
04/01/2010: Multiple Procedure Payment Reductions II: Outpatient Services
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3/19/2010: MUE Update
3/05/2010: Coding & Reimbursement Update
3/5/2010: RAC Audits Part 1
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2/05/2010: Urinalysis Codes
01/29/2010: Dialysis Access Maintenance Coding
1/22/2010: Drug Screening Codes
01/08/2010: Medicare Fee Schedule Updates
CodeMap Compliance Briefing: 1/7/2010
2010 Publication Notice
2010 CodeMap® Publications Shipping Update
12/11/2009: Year End Coding Changes
12/04/2009: Travel Allowance Reimbursement
11/20/2009: Diagnosis Coding Rules for Pathologists
11/13/2009: Diagnostic Coding Rules for Laboratories
11/06/2009: Coding for Mammography Services
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10/23/2009: Civil Monetary Penalties
10/15/2009: HIPAA Amendments
10/02/2009: Proposed Medicare Coverage for HIV Screening
09/25/2009: Radiology Services in the Emergency Room
Upcoming Coding and Reimbursement Changes
09/18/2009: Essential Health Information System Updates
CodeMap Radiology Briefing: 09/11/2009: Compliance Vocabulary
08/28/2009 Reimbursement for Lab CPT Codes
08/21/2009: Utilization of Radiology Services
08/14/2009 Creating New CPT Codes
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08/07/2009: Supervision Requirements
07/31/2009 Physician Signature Requirements
07/31/2009: Medicare Administration/Organization
07/24/2009: Health Care Reform and the Future
07/24/2009: Ultrasound Coding, Part 2
07/17/2009: New Information and Hospital Lab Direct Billing Rules
07/10/2009: Ultrasound Coding, Part 1
06/26/2009: The Future of Medical Necessity
06/19/2009: Employee Screening
06/17/2009: Documentation Requirements: Part 2
06/05/2009: NPI Issues
05/29/2009: Documentation Requirements
05/22/2009: Who Can Order Tests for Medicare Patients?
05/15/2009: The Civil False Claims Act
5/1/09: Coding Molecular Microarray Procedures
4/24/2009: Diagnostic Test Orders
4/17/09: Comparative Effectiveness Studies
4/03/2009: Fluoroscopy Coding Part 2
4/03/09: Medicare Recovery Audit (RAC) Contractor Program
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03/20/2009: Compliance Risk Areas
03/13/09: The Terminology of Reimbursement
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02/27/2009: New ABN Form
Q2 NCD Updates
02/20/2009: Discounts for Financially Needy Patients
02/13/2009: The Terminology of Coding
2/06/09: In Vivo Lab Procedures
1/30/09: ICD-10 Implementation, Final Rule
1/23/09: 2009 Laboratory Fee Schedule
CodeMap Radiology Briefing: 01/14/2009
CodeMap Compliance Briefing: 01/14/2009
CodeMap Compliance Briefing: 12/19/08: Prostate Saturation Biopsies
12/19/2008: Year End Radiology Wrap-Up
NCD Q1 2009 Breaking News
12/05/2008: Anti-Markup Provisions
12/2/2008: Interventional Radiology Coding Conclusion 2
11/25/2008: Interventional Radiology Coding Conclusion
11/21/2008: Civil Monetary Penalties
11/12/08: Clinical Laboratory Interpretation Services
11/07/2008: Interventional Radiology Coding 3
10/29/08: MUE Update
10/24/2008: Interventional Radiology Coding 2
10/15/08: The NCD Update Process
10/10/2008: Interventional Radiology Coding 1
10/08/2008: 2009 Payment Recommendations
10/01/08: Two Issues Resolved
9/19/08: Coding and Reimbursement for HIV Tests
9/12/08: The Terminology of Reimbursement
9/5/08: The Terminology of Coding
8/22/08: Recent Subscriber Questions
08/08/2008: New PSA Screening Criteria
7/25/2008: 2008 Travel Allowances
7/17/2008: Medicare Improvements Act
6/27/2008: New Laboratory CPT Codes
6/20/2008: Medicare Payment Systems for Lab Tests III
July 2008 NCD Update
6/6/2008: Medicare Payment Systems for Lab Tests II
05/30/2008 Physician Signature Policy for Lab Claims
05/23/2008: Medicare Payment Systems for Lab Tests
05/09/2008: HCPCS Coding System
05/02/2008: Fecal Occult Blood Tests
04/25/2008 Routine Monitoring vs. Diagnostic Glucose Testing
04/11/2008: Subscriber Questions
04/04/2008: Relying on Guidance
03/28/2008: Comparative Effectiveness
03/14/2008: New ABN Form
02/22/08: Standing Orders
02/15/2008: New Metabolic Panels
2/8/2008: Diagnosis Coding Rules for Labs
02/01/2008: Using Unlisted CPT Codes
01/18/2008: Home PT/INR Testing and Monitoring
01/11/2008: Significant Changes to 2008 Physician Fee Schedule
CodeMap Compliance Briefing: 01/03/2008: Annual Compliance Audits
CodeMap Compliance Briefing: 12/14/07: 2008 PFS: New Direct Billing Provisions
12/07/07: Reconsideration of Medicare Payment for New Lab Codes
11/30/07 - Changes in Pathology Reimbursement for 2008
11/16/2007 Medical Necessity Data Files
11/9/2007: Direct Billing Rules for Hospital Laboratories
11/2/07: Payment Jurisdiction for Referred Lab Tests
10/19/07: OIG Work Plan 2008
10/12/07: Medicare Coverage of Hospital-Acquired Conditions
9/28/2007: Medicare Reimbursement for 2008 Lab Codes
9/21/07: Coding and Reimbursement for MRSA Tests
9/14/07: Coding Pap Smears
9/7/07: Date of Service Rules
8/24/07: TeleConference Tools
CodeMap Compliance Briefing: 8/17/07: Medicare Claims Processing Rules
8/10/07: Procedure Code Modifiers
7/27/07 Billing Medicare for Peripheral Blood Smear Interpretations
7/20/07: 2008 ICD-9 Code Changes
7/13/07: New 2008 Laboratory CPT Codes
6/22/07: Excessive Charges to Medicare
6/15/07: Compliance Training
6/08/07: Glucose Testing for Hospital Patients
6/01/07: Reimbursement for Unlited Procedures
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5/4/07: Molecular Diagnostic Codes and Reimbursement
04/20/2007: Medicare Coverage Vocabulary
04/13/2007: Coding Vocabulary
03/30/2007: Reimbursement Vocabulary
03/23/07: Compliance Vocabulary
3/16/07: Medically Unlikely Edits (MUE) Implementation
3/2/07: The Physician Quality Reporting Initiative (PQRI)
CodeMap Compliance Briefing: 2/23/07: New Anticoagulant Management Codes
2/09/07: Glycosylated Hemoglobin (A1c) Test Codes
02/02/2007 National Provider Identifiers
CodeMap Compliance Briefing: 1/26/07: The Deficit Reduction Act
CodeMap Compliance Briefing: 1/19/07: The Civil False Claims Act
12/19/06 Medically Unlikely Edits (MUEs)
12/11/06 - 2007 Medicare Laboratory Fee Schedule
CodeMap Compliance Briefing: 12/1/06: Category III Codes
11/17/2006 2007 Radiology CPT Codes
11/10/06 New and Revised CPT Codes for Laboratory and Pathology Procedures
11/03/06 Logical Observation Identifier Names and Codes
10/20/06 Dealing with Medicare Overpayments 
10/13/06 Stark II Issues, Part 2
10/6/06: Stark II Issues, Part 1
09/29/2006 Medical Necessity Updates
09/15/06: Medicare Coverage of PSA Testing
9/8/06 Public Consultation on Medicare Payment for Lab Tests
08/25/06: Point of Care Hemoglobin A1c Testing
08/21/06 Subscriber Questions
08/11/06 CMS Awards First A/B MAC Contract
7/21/06 Medicare Coding Vocabulary
7/14/06 Setting Reimbursement Amounts for New 2007 Codes
07/07/06: New 2007 Laboratory CPT Codes
06/09/2006 Competitive Bidding III
06/02/2006 Competitive Bidding II
05/26/2006 Competitive Bidding I
05/12/2006 Briefing: ABN Update
CodeMap Compliance Briefing: 5/5/06: Subscriber Questions
04/28/2006: Billing for Purchased Interpretations
CodeMap Compliance Briefing 4/21/06
03/31/2006: Physician Voluntary Reporting System
03/24/06 Medicare Organization/ Administration
03/17/2006: Compliance Disclosure Programs
03/10/06: Automated Test Coding and Reimbursement
02/24/2006 Pay for Performance
02/17/2006: Inherent Reasonableness
2/10/06: Microarray Codes
02/03/2006 Refresher Course: Compliance Programs
01/20/2006 Refesher Course: Medicare Reimbursement
01/13/06: Laboratory Phlebotomists in Physician Offices
CodeMap Compliance Briefing: 1/06/06 2006 Federal Budget
CodeMap Compliance Briefing: 12/16/05: Lipid Codes
CodeMap Compliance Briefing: 12/9/05: Important Year End Dates
12/02/05 Fecal Occult Blood Tests
11/18/05 Employee Compliance Training
11/04/2005 New CPT Codes for Radiology
Compliance Policy Manual
10/21/2005: New CPT Codes for Lab and Pathology
CodeMap Compliance Briefing: 10/14/05: Providing Regulatory Information to Customers
CodeMap Compliance Briefing: 10/07/05: Employee Screening
CodeMap Compliance Briefing: 9/29/05: Waived Testing
CodeMap Compliance Briefing: 09/23/05: Drafting Compliance Policies
09/16/2005 2006 Lab Codes and Proposed Payments
09/09/2005: LIS and Medical Necessity
08/19/2005: Lab Tests on the 2006 Physician Fee Schedule
08/05/2005 Coding Bone Marrow and Bone Biopsies
CodeMap Compliance Briefing 07/22/05: Coding Antibody and Antigen Assays II
07/08/2005 Coding Antibody and Antigen Assays: I
06/24/2005 Resubmitting Denied Medicare Claims
06/17/2005 Diagnosis Coding Rules-Part 2
05/20/05 Diagnosis Coding Rules Part 1
05/13/2005 Reflex Manual WBC Differentials
05/06/2005 Incident To Services
04/29/2005 CMS Manuals
04/22/2005 Reflex Testing
04/15/2005 Custom Panels
04/08/2005 Medicare Administrative Contractors (MACs)
04/01/2005 Place of Service (POS) Codes
03/18/2005 Subscriber Questions
03/11/2005 Medically Unbelieveable Edits
03/04/2005: Final Hospital Compliance Guidance 4
02/25/2005: Final Hospital Compliance Guidance 3
02/18/2005 Final Hospital Compliance Guidance 2
02/11/2005 Final Hospital Compliance Guidance
02/04/2005 Final Diabetes Screening Rules
01/28/2005 Medicare Appeals II
01/21/2005: Medicare Appeals I
01/14/2005 Providing Services to SNFs
01/07/2005 Medicare Errors
12/17/2004 Year End Subscriber Questions
12/10/2004 Coding Flow Cytometry Services
12/08/2004 Alert: 2005 CodeMap Manual Production Schedule
12/03/2004 Diabetes Screening Tests
11/22/2004 Announcing CodeMap Data Files
11/19/2004 Flow Cytometry Coding and Reimbursement
11/12/2004 New Venipuncture Rules
11/05/2004 Medicare Cardiovascular Screening Benefits
10/29/2004 Subscriber Questions
10/22/2004 Genetic Testing Modifiers
10/15/2004 Coding Glucose Tests
10/08/2004 Shared Laboratories
10/01/2004 Stark II and POLs
09/24/2004 New CPT Codes for Pathology Services
09/17/2004 New CPT Codes for Lab Services
08/27/2004 SNF Consolidated Billing Exceptions
08/20/2004 The OIG Exclusion Program
08/13/2004 Medicare Initial Preventive Physical Exam
08/06/2004 New Medicare Coverage for Screening Tests
07/30/2004 Discounts to Financially Needy Patients
07/23/2004 Date of Service for Lab Tests
07/16/2004 New CPT Codes for 2005
06/25/2004 Updates to NCDs and LMRPs
06/18/2004 New Compliance Program Guidance for Hospitals II
06/11/2004 New Compliance Program Guidance for Hospitals II
06/04/2004 Annual Physician Notices
05/21/2004 Screening Pap Smear Coverge
05/14/2004 Transfusion Medicine Codes II
05/07/2004 Transfusion Medicine Codes I
04/23/2004 Anti-Mark-Up Controversy
04/16/2004 Subscriber Questions
04/09/2004 Genetic Testing Codes II
04/02/2004 Genetic Testing Codes I
03/26/2004 Laboratory Marketing Practices III
03/19/2004 Laboratory Marketing Practices II
03/12/2004 Laboratory Marketing Practices I
03/05/2004 Medicare Payment for CLIA Waived Tests
02/27/2004 Medicare Payment for ReferredTests
02/20/2004 Grace Period for CPT Codes Eliminated
02/14/2004 CCI Edits Associated with New Lab and Pathology Codes
02/06/2004 CCI Edits Associated with New Radiology Codes
01/30/2004 Venipunctures
01/23/2004 The Medicare Prescription Drug, Improvement, and Modernization Act of 2003
01/16/2004 Travel Allowances
12/19/2003 Medicare Modernization Act
12/12/2003 Medicare Reform Bill Part 2
12/05/2003 Medicare Reform Bill Part 1
11/21/2003 New HCPCS Codes for CBCs without Platelets
11/07/2003 GA, GY and GZ Modifiers
10/31/2003 Specimen Collection
10/24/2003 Coding Qualitative Drugs-of-Abuse Tests
10/17/2003 The OIG's Work Plan, Medicare CDs, Recent Enforcement Actions.
10/10/2003 ESRD Composite Rate Lab Tests
10/03/2003 End Stage Renal Disease (ESRD) Reimbursement for Automated Tests
09/26/2003 Proposed Rules from the OIG
09/12/2003 Category III (Tracking) CPT Codes
09/05/2003 New Proposed Rules for Flow Cytometry
08/15/2003 Thyroid Testing
08/01/2003 CMS Lab Reimbursement Meeting
07/25/2003 NCD Misconceptions
07/18/2003 The -GZ Modifier
07/11/2003 Screening Mammogram Codes
06/27/2003 Correct Coding Edits II
06/20/2003 Correct Coding Edits I
06/13/2003 Diagnosis Coding Rules II
06/06/2003 Diagnosis Coding Rules I
05/23/2003 Revised Medicare Appeals Provisions II
05/16/2003 Revised Medicare Appeals Provisions I
05/09/2003 Business Associates Agreements
05/02/2003 Pathologist Interpretation of Clinical Lab Tests
04/25/2003 TC Billing of Pathology Services
04/18/2003 Medicare Reimbursement for Pathology Services
04/11/2003 How to Respond to a Search Warrant
03/28/2003 How to Respond to Subpoenas
03/21/2003 How to Respond to Investigators
03/14/2003 Mandatory Claim Submission
03/07/2003: Who Can Order Diagnostic Tests?
02/28/2003 Changes in 2003 Physician Fee Schedule
02/21/2003 Medical Necessity Requirements for Chemistry Panels, Part II
02/14/2003 Medical Necessity Requirements for Chemistry Panels I
02/07/2003: ABNs and Client Cooperation
01/31/2003: Patient Ordered and/or Performed Testing
01/24/2003: The Beneficiary Anti-Kickback Statute
01/17/2003: Significant Changes in 2003 Medicare Reimbursement
01/10/2003: 2003 Medicare Lab and Physician Fee Schedules
12/13/2002: More National Coverage Policies
12/06/2002: How Medicare Sets Fees for New CPT Codes
11/22/2002: Critical Year End Dates
11/15/2002: 2003 Medicare Laboratory Fee Schedule
11/08/2002: Stark Self-Referral Prohibitions
11/01/2002: Using Modifiers -59 and -91
10/25/2002: Introduction to Privacy Regulations
10/18/2002: New Codes for Obstetrical Ultrasound
10/11/2002: National Coverage Determinations (NCDs)
10/04/2002: Implementing a Radiology Compliance Program
09/27/2002: New 2003 Lab CPT Codes
09/20/2002: Automated Order Entry
09/13/2002: National Coverage Policy for Lipids
09/06/2002: The Anti-Kickback Statute
08/23/2002: Using the New ABN Forms
08/16/2002: Advance Beneficiary Notices
08/09/2002: Medicare Coverage for PET Scans
08/02/2002: Reflex Testing
07/26/2002: 2003 Hematology CPT Code Changes II
07/19/2002: 2003 Hematology CPT Code Changes I
07/12/2002: Direct Billing Rules II
06/28/2002: Direct Billing Rules I
06/21/2002: Medicare Reimbursement for Lipid Panels
06/14/2002: Bone Density Studies
06/07/2002: CLIA Waived Testing Rules
05/31/2002: Blood Draws and the Anti-kickback Statute
National Coverage Determination (NCD) Updates
05/01/2002 - CodeMap® Quarterly Reports, Volume I, No. 2
01/15/2002 - CodeMap® Quarterly Reports, Volume I, No. 1