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Selected Independent Clinical Laboratory Billing Requirements

An independent clinical laboratory is one that is independent both of an attending or consulting physician’s office and of a hospital. Previous OIG audits, investigations, and inspections have identified independent clinical laboratory areas at risk for noncompliance with Medicare billing requirements. Payments to service providers are precluded unless the provider has and furnishes upon request the information necessary to determine the amounts due (SSA § 1833(e)). We will review Medicare payments to independent clinical laboratories to determine laboratories’ compliance with selected billing requirements. We will focus on independent clinical laboratories with claims that may be at risk for overpayments. We will use the results of these reviews to identify clinical laboratories that routinely submit improper claims, and we will recommend recovery of overpayments.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services Selected Independent Clinical Laboratory Billing Requirements Office of Audit Services W-00-17-35726; various reviews 2018

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