REIMBURSEMENT CHALLENGES...
turned up the heat on POL billing, coding, and
reimbursement.
Schedule (CLFS) for 2015, and watch what
Medicare does with the 52+ new CPT codes
proposed by the AMA for Drugs of Abuse
testing. It is uncertain whether Medicare will
adopt these codes or pursue a more
manageable coding and reimbursement
platform that will allow federal payers to
more easily edit and reclaim monies lost to
medically unnecessary testing.
About the Author
Jennifer Bolen, JD, is a former federal
prosecutor and twenty-five year attorney. She
is nationally recognized as an expert in
business structure of in-office toxicology
laboratories, billing, coding, and medical
necessity associated with clinical laboratory
testing (in-office and independent
laboratory), and health care fraud and abuse
in the clinical laboratory setting. She is also
nationally recognized as a legal expert on
matters pertaining to pain management and
controlled substance prescribing. She
consults with MTL Solutions, a group of
business and medical professionals who are
experts in laboratory management topics. She
also consults with several POLs and
independent clinical laboratories.
Summary
Prior to setting up an in-office toxicology
laboratory, or if a restructure is necessary,
physicians should consult with true experts to
evaluate the realities of reimbursement
associated with clinical laboratory services in
light of medically necessary testing as defined
by payers and state licensing board materials.
Failure to do so may expose the physician to
devastating financial penalties, exclusion from
government and private payor programs, and
even loss of medical licenses. Careful planning
and review is critical now that the payers have
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