2018 Regulatory Update: Hospital Laboratory Outreach Programs
Wednesday, June 27, 2018
2:00-3:15 pm ET
Each year, we devote an entire CodeMap® Webinar to the regulatory issues that confront all hospital laboratories that maintain outreach programs. This year marks the 10-year anniversary of our outreach program regulatory update. As is customary, we will focus on issues that have consistently been identified by our subscribers as complex, confusing, and/or worrisome. We chose the topics listed below based upon subscriber questions and suggestions submitted to us via calls and emails. These issues are also important considering recent and ongoing DOJ and OIG investigations and settlements.
The 2018 Regulatory Update will address the legal and regulatory implications of the following:
14 Day Rule and Outpatient Bundling: CMS recently revised the 14 day rule creating significant confusion amongst hospitals and laboratories performing molecular pathology tests and procedures. We will explain this often confusing rule and help your facility understand exactly which entity may bill for tests and procedures performed for hospital outpatients. We will also review the outpatient bundling rules concerning laboratory tests and the technical component of pathology services. These rules demand that hospital labs carefully consider how they form relationships, including client-billing arrangements, with other hospitals, reference laboratories, and referring practitioners.
HIPAA Update: The federal government continues to investigate alleged violations of the HIPAA Privacy and Security Rules. Even though most hospitals have implemented HIPAA compliance programs, all providers must pay attention to HIPAA and its strenuous requirements. We will discuss developing compliance issues concerning inadvertent disclosures, breaches of protected health information, and recent enforcement actions.
Medical Necessity Screening: All laboratories should screen test orders and claims for medical necessity compliance. We will discuss good practices and associated risk areas. We will also review how the Medicare program develops coverage policies, such as NCDs and LCDS, and how CMS and federal contractors continuously update these policies.
Disclosure Programs and Investigations: A robust and functioning disclosure program is a crucial component of any effective compliance program. Hospital laboratories must create effective policies and procedures that go beyond the operation of a compliance hotline or website. We will review applicable OIG compliance guidance concerning disclosure programs and requirements included in recent settlements and corporate integrity agreements.
Video of Presentation and PDF Handouts.