May 20, 2016Pass-Through Billingand Shared LabsPass-through billing has mostly passed on.Pass-through billing is an arrangementbetween a physician practice and areference laboratory that allows thephysician practice to submit specimens tothe reference lab for testing, pay thatlaboratory directly, and then bill the payer(insurance or patient) for the test, usually ata higher fee. This practice, in which thephysician makes a profit for work done byanother entity, is prohibited by Medicareand Medicaid.CMS requires all laboratory tests to bebilled by the laboratory that does the work.Some states and some private payershave similar restrictions. Examples are theState of Tennessee, United Healthcare,BCBS of Texas and BCBS of Alabama.Even when billing only private payers, thiscould be considered inducement and couldbe against the law- the Anti-KickbackStatute. This is because the physicianwould be more likely to sendMedicare/Medicaid testing to thelaboratory that allows pass-through billing,also known as client or account billing.The Federal Anti-Kickback StatuteSample the benefit of a NAMASmembership with a FREE ondemand webinar!Unsure if a NAMAS membership isright for you? Sample our mostrecent webinar and see whatyou're missing. Click the imagebelow to listen to: E/M EncounterReview presented by AimeeWilcox, Director of ContentCreation forFind-A-Code!NAMAS is the leading source ofCEU's for maintenance of yourcredentials- including those hard tofind CEU's for CPMA!We offer 4 membership levelschoose the one that best suitsyour needs!Click Here to View NAMASMembership Levels andBenefits
prohibits "knowingly and willfully offering,paying, soliciting or receivingremuneration to induce referrals.ofservices covered by Medicare, Medicaidor any federally funded program." 42.U.S.C. § 1320a-7b(b).Beyond specific laws and payerrestrictions, every clinician should holdthemselves and their practice(s) to thehighest ethical standards possible. TheAmerican Medical Association and theAmerican Society of Clinical Pathologyhave issued ethical guidelines onarrangements that allow physicians to profitfrom work done by others when the patientis ultimately the payer.Exceptions:1. CMS does allow physicians to purchasethe technical component of pathologyservices but only if the practice reads itsown slides. However, the practice can billonly the actual amount it paid the referencelab for the slide preparation.2. CMS does allow pass-through billing forsome drugs, biological andradiopharmaceuticals- a completelydifference service.3. A physician practice may bill for referredtests only if it does not refer more than30% of the clinical laboratory tests requiredduring the year. This comes under"purchased services" and is allowed only ifthe reference lab does not also bill for thetests.For added convenience, NAMASaccepts PayPal, PayPal Credit,quarterly and monthly payments ofmembership dues.Click Here to Join Today!NAMAS 1 Day E/MAuditingBoot CampWhether you're new to E/Mauditing, or are an experiencedauditor, this course will leave youwith a new perspective on E/Mauditing. Our experiencedinstructors will dig into the details ofE/M auditing, covering topics like:medical decision making, medicalnecessity, 1995/1997 guidelines,the grey areas of audit policies,and more!Earn 8 AAPC CEUs for attendingthis course. Your registration alsoincludes your curriculum manual,NAMAS audit grid, and a 1 yearNAMAS membership!Shared LaboratoriesUpcoming Classes:Stark laws prohibit a physician fromreferring patients to an entity in which he orshe has a financial stake. Stark applies onlyto Medicare and Medicaid, but somestates such as California and New Yorkhave their own regulations which alsoprohibit self-referrals.June 7, 2016: Saratoga, NYJune 17, 2016: Orlando, FLJune 21, 2016: Albuquerque, NMJune 28, 2016: Dallas, TXOne exception to the Stark Regulation isthe in-house laboratory owned by onephysician or a group practice. These labsare known as "Physician OfficeLaboratories" or POLs. Laboratoriesowned by group practice must be in thesame building as the practice or in anotherPlease call or email NAMAS toregister for this sessionJuly 7, 2016: Charlotte, NCJuly 12, 2016: Detroit, MI
building used by the group practice forancillary services.Group practices must be legally-organizedas a partnership, corporation, foundation,not-for-profit corporation or similarassociation. Substantially all (considered tobe at least 75%) of all patient servicesmust be provided through the group;patient care services must be billed in thename of the group, and reimbursementreceived must be treated as receipts of thegroup. Laboratories located outside aMetropolitan Statistical area are alsoexempt, with the caveat that at least 75%of the laboratory services must beprovided to individuals residing in a ruralarea.A shared laboratory is a clinical laboratoryowned by more than one practiceoperating in the same building, with eachphysician "directly" supervising laboratorystaff while they are running tests for his/herpatients, and with each physician billingindividually for the tests performed onhis/her patients. All participating physiciansor physician practices must be on thesame floor of the building as the laboratory,so that the supervision requirement can befulfilled.CLIA, the Clinical Laboratory ImprovementAmendments, includes "shared lab" as anoption on its application, form CMS 116,although the regulation does not addressshared laboratories. From a CLIAcompliance standpoint, there are somerecommendations to clarify operationalseparation of the entities owning andtesting in a shared lab:There can be only one CLIAcertificate and one laboratorydirectorThe laboratory should, however,enroll in separate proficiency testingprograms for each participatingpractice.Other documentation such asmanuals, personnel files and qualitycontrol records may be shared.There are some additional arrangementsJuly 21, 2016: Houston, TXPlease call or email NAMAS Toregister for this sessionNew! Live Online Sessionbeginning August 9th!Additional dates and citiesscheduled; click the image abovefor full scheduleCurrent NAMAS members save 100 on Boot Campregistration!Click here for detailsWeekly Tip SponsorNAMAS Calendar ofEventsClick the image above to view ourmonthly calendarUpcoming WebinarsNAMAS is proud to present thefollowing webinars in May
that could ultimately be considered sharedlabs, even though they use it on differentdays.Laboratory space, equipment andmaybe even personnel are used bydifferent practices on separate days.One practice owns the laboratory butanother practice leases thelaboratory, including its personnel, oncertain days only.This Week's Audit Tip Provided by:Ann Bachman, CLC(AMT), MT (ASCP)Ann is the Director ofOSHA, CLIA, HIPAACompliance Department forDoctorsManagment and isalso the Founder andExecutive Director of theAmerican Association ofPhysician Offices andLaboratories (AAPOL)References:1. "Physicians Should beWary of Labs OfferingIncentives." Physicians Practice blog, Feb. 27,20132. BCBSTX notices3. "Pass Through Billing: Risky Business" Mondaq;Sept.29, 20114. CMS Regulations and GuidanceNAMAS 8th Annual Auditing &Compliance ConferenceMitigating Your Practices' RiskSpeaker: Frank CohenMay 24, 20162pm ESTForensic and Compliance RiskAuditing DistinguisedSpeaker: Michael MiscoeJune 7, 20162pm ESTWriting an Effective ResumeJune 14, 20162pm ESTCreating & Maintaining anEffective Compliance AndAuditing ProgramSpeaker: Daniel FlynnJune 21, 20162pm ESTE/M Encounter ReviewSpeaker: Michelle WestJune 28, 20162pm ESTNAMAS Members: Watch yourEmail for Registration LinksNon-Members: [email protected] to learn how toattend these webinarsJust Released & NowTaking Pre-OrdersPre-Conference:Dec 6 2016Conference:December 7-9 2016Location:Loews Portofino Bay HotelOrlando, FL
Click Here to View theConference AgendaNew for 2016!Attendees can choose betweenFOUR Pre-Conference tracks: GeneralAuditing, E/M Auditing with PrecisionTesting, Physician-Based Compliance andFacility-Based Auditing presented byPanacea Healthcare Solutions. Agenda forthe facility-based auditing track will bereleased soonLimited Time Offer! Ends 4/30/16Register for conference and receiveregistration to our pre-conference forFREE!Reserve your spot at conferencewith just a 50 deposit!Click here to reserve yourconference registrationA Note From Our Sponsor2016 E/M Auditing Training &Reference GuideThis manual, designed exclusivelyfor our E/M Auditing BootCampsbreaks down the components ofE/M auditing, explaining topicssuch as history of the encounter,medical necessity, medicaldecision making, and grey areasof auditing policies.This manual is ideal for both newand seasoned auditors alike.This manual is currently inproduction, but we are acceptingpre-orders. All pre-orders will beshipped as soon as they areavailable.Click the image above for moreinformation and to place your preorder.BarCharts has been publishingQuickStudy guides since 1991.Our guides help medical professionalslearn large sums of information quickly andconveniently. They are jammed-packedwith key facts that are color-coded andorganized.We have the medical field covered when itcomes to quick reference.Instead of searching through those largemedical manuals to find the information youneed quickly, find it with QuickStudy .With detailed illustrations and boldheadings our guides make it easy to findthe answer.A Note fromPowerBuying:Save on Office SuppliesUsing Staples Advantage throughDoctorsManagement'sPowerBuying division can saveyour organization money on officesupplies!
Click the image above to learn more aboutBarChartsA Note From Our ParentOrganization:DoctorsManagement, LLCFee Schedule Workbookby StateThe fee schedule is the most importantfinancial tool in any business and a medicalpractice is no exception. Having a properlyprepared and defensible fee schedule isparamount when it comes to fairly andhonestly representing the value of theservices and procedures provided by ahealthcare provider.Click the image above to learn more andpurchaseIn addition to cost savings, StaplesAdvantage offers proactiveaccount and programmanagement that provides aconsultative approach to designingand managing a program just foryour organization.To start saving, contact Craig Kingtoday at 800-635-4040 or [email protected] weekly auditing & compliancetip emails are available to anyonewho could benefit from thisinformation.If you know someone who wouldlike to receive these emails, invitethem to sign.Click the image above to beadded to our email list!Stay InfomedStay up to date with importantnews and announcements fromNAMAS. Follow our social mediapages to ensure you don't miss abeat!In This IssueNAMAS 8th Annual ConferenceBarCharts PublishingDoctorsManagementBecome a NAMAS MemberE/M Auditing BootCampsCalendar of EventsUpcoming WebinarsPowerBuying DiscountsReceive These Tips
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