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CodeMap® 01/28/2021: Risky Claims Submission Practices

CodeMap® Compliance Briefing: January 28, 2021


Editor's Welcome:  

Today, we will discuss four claims submission practices that may expose a clinical laboratory to significant risk and subsequent liability. As will be explained with examples and recent enforcement actions, these practices violate coding conventions, Medicare claims submission rules, and the Civil False Claims Act. This CodeMap® Compliance Briefing warns all clinical laboratories to avoid unbundling, upcoding, submitting claims for tests not covered by Medicare, and using inaccurate or misleading codes to report testing. As always, please send us your questions, comments, and suggestions to us via email.

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CPT copyright 2020 American Medical Association. All rights reserved.

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



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