2021 Regulatory Update:
Hospital Laboratory Outreach Programs
Wednesday, June 23, 2021
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. As is customary, we chose the topics listed below based upon subscriber questions and suggestions submitted to us via calls and emails.
- HIPAA and the Pandemic: The COVID-19 pandemic has significantly altered how most businesses operate, including hospital and reference laboratories. Many of these changes affect how your laboratory maintains its HIPAA compliance program. We will examine how HIPAA compliance is affected by working from home, increased reliance on portable electronic devices, particularly laptops, and lost shipments of specimens and/or protected health information.
- Communicating with Customers: All laboratories must communicate with their customers. This webinar will focus on client service activities, communications required by OIG compliance guidance such as Annual Physician Notices and Acknowledgements, and voluntary communications such as newsletters and compliance alerts. Labs must understand the potential compliance issues.
- Stark Law Compliance: The federal government continues to more actively enforce the Stark Law. In addition, many laboratories continue to self-report violations of these self-referral prohibitions. We will revisit the Stark Law and the many developing issues surrounding this complex legislation and its regulations. We will focus on sales and marketing activities, the non-monetary compensation exception, physician ownership problems, and other recent enforcement actions.
- CCI and MUE Edits: Correct Coding Initiative (CCI) Edits and Medically Unlikely Edits (MUE) are leading causes of Medicare denials. CCI edits highlight particular CPT® code pairs that will result in the denial of one of the tests or procedures if performed on the same date of service for a Medicare beneficiary. MUEs are unit-of-service edits that screen a Medicare claim for the same beneficiary, procedure code, date of service, and billing provider against a defined number of units of service. Medicare contractors employ literally thousands of CCI and MUE edits. Your organization should know not only how these edits work, but also how to appropriately overcome them when necessary.
- The Fundamentals of Medicare Coverage: Finally, we will review the laws, rules, and regulations that govern the coverage requirements of federally funded health care programs. Learn how CMS and its contractors use National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and Local Coverage Articles (LCAs) to restrict coverage of tests and procedures and how laboratories can achieve compliance with these requirements.
We will discuss not only the requirements of the applicable laws and regulations, but also strategies and advice to help your organization comply and succeed.