Been avoiding the CLIA rules? You may not get paid for lab tests

Article Abstract:

The federal government plans to more strictly enforce rules of the Clinical Laboratory Improvement Amendments of 1988 (CLIA), by denying claims to physicians who do not perform in-office laboratory tests that meet federal regulations. Beginning on July 1, 1997, Medicare carriers will be required to strictly comply with CLIA regulations in order to receive payment for laboratory work. As of Jan. 1, 1998, all physicians will have to follow CLIA rules in order to file a claim. The enforcement plan is an attempt to recover money lost to non-compliant procedures.

Regulation, Licensing, and Inspection of Miscellaneous Commercial Sectors, Health Regulation, Insurance claims adjustment, Medicare, Medical law

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Details still not clear on self-referral ban

Article Abstract:

Several questions remain regarding the Health Care Financing Administration's ban on physician referrals. The ban makes illegal the referral of patients to facilities owned by the physician or the physician's family. However, the agency's guidance memo that supposedly communicated details of the ban resulted in more confusion than understanding. Physicians and medical advocacy groups want to know several things, such as what constitutes a referral and whether physicians can refer patients to shared medical facilities.

Health Care, Health Care and Social Assistance, HEALTH SERVICES, Offices & clinics of medical doctors, Physicians & Surgeons, Offices of Physicians (except Mental Health Specialists), Health facilities, Medical referral, United States. Centers for Medicare and Medicaid Services

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