Course Outline
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- Voluntary Compliance Program
- Introduction
- What is a Voluntary Compliance Program?
- Seven Elements of a Compliance Program
- Laws and Regulations
- Laws and Regulations Applicable to Medicare
- Case Study 1: Laws and RegulationsA laboratory located within an urban hospital provides testing for the hospital and for the hospital's outreach test...
- Compliance Issues
- Confidentiality
- Confidentiality
- Case Study 2: Confidentiality and Compliance IssuesTwo hospital employees, a billing clerk and a clinical laboratory professional (from a different de...
- Billing
- Inducements
- Marketing and Record Retention
- Kick-Backs and Inducements
- Phlebotomists and Equipment in Client Offices
- Utilization and Other Regulations
- Couriers and Referral Tests
- Case Study 3: InducementsA laboratory-contracted courier is making a routine stop in a client's office and is approached by the office manager with wh...
- Case Study 4: UtilizationA client service representative receives a call from a major laboratory client. The client is requesting the laboratory to wr...
- Documentation
- Whistleblowers
- Processes and issues related to Medicare Reimbursement
- Medical Necessity
- ABNs
- Advance Beneficiary Notice (ABN)
- ABN Form CMS-R-131
- Case Study 5: ABNsA phlebotomist from the laboratory draws blood samples in a nursing home every day. The phlebotomist picks up the requisitions for b...
- Coding
- International Classification of Disease (ICD) Coding
- HCPCS and CPT-4 Coding
- Test Ordering
- Orders
- Test Requisitions
- Issues Related to Test Ordering, Performance, and Resulting
- Written and Verbal Orders
- Ambiguous or Unclear Test Orders
- Case Study 6: Unclear Test OrdersIt is 11:00 PM and the specimen collection and processing department is finishing up the night's accessioning and tes...
- Tests
- Responsibilities for Medicare Compliance
- Laboratory Administration's Responsibilities
- Management Personnel Responsibilities
- Employee's Responsibility
- Case Study 7: Management ResponsibilitiesThe setting is a large reference laboratory that processes a high volume of tests with turnaround time deadli...
- Case Study 8: Employee ResponsibilityTwo clerks are working in close proximity to each other in a billing office. A billing clerk notices that one of ...
- Billing Department
- Sales and Marketing
- Equipment, contracts, and pricing
- References
Additional Information
Level of Instruction: Basic.
Intended Audience: All clinical laboratory personnel.
Author information: Christopher Young, of Laboratory Management Support Services, Phoenix, AZ, is an independent consultant, and nationally recognized speaker and expert currently specializing in compliance, sales and marketing, and customer service, as they pertain to clinical laboratories. He has extensive first-hand laboratory experience, in positions ranging from phlebotomist, to decision support coordinator, and in his consulting practice.
Reviewer information: Barbara Cebulski, MS, MLS(ASCP) has over 40 years of experience in the medical laboratory profession as a technologist, section supervisor, and laboratory manager. She was an Inspection and Technical Specialist for nine years with the College of American Pathologists in the Laboratory Accreditation Program and, until her retirement in 2015, was Program Director for MediaLab, Inc. Barbara holds a Masters in Instructional Technology from Georgia State University.
Course Description: This course is designed to train laboratory staff on the basic concepts of Medicare compliance. It is based on the OIG Compliance Program Guidance for Clinical Laboratories, and covers seven elements of a successful compliance program: risk areas, coding, ABNs, tests and panels, inducements, billing, and whistleblowers. It includes real-life case studies that highlight pertinent issues.
