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CLIA Medicare billing

This article was originally published in The Gray Sheet

Executive Summary

OIG recommends CMS prohibit labs from billing Medicare until they have paid all CLIA fees or been surveyed for compliance. Less than 1% of a 26,500-lab sample were paid by CMS for services not authorized by their waiver certificate in 1999, according to a January OIG report. The claims accounted for less than $76,000 of about $31.3 mil. paid for services submitted by waived labs. Based on the sample, OIG finds that CMS' Common Working File edits appear to be effective, resulting in denial of payment of 998 of 1,000 services...
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