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Q: I have a follow-up question to last week’s answer about lab payments. We should receive payment for a lab-only claim because of the new Q4 status indicator. However, we noticed that sometimes we do and sometimes we don’t. The difference seems to be when we report a venipuncture and when we report the blood being drawn from a ventricular assist device (VAD). When the venipuncture is reported, we get paid for all line items. When the blood draw is from a VAD, we don’t get paid for the lab work. Is this correct?

Medicare continually seeks to expand access to certain basic health care services, particularly for beneficiaries located in remote areas of the country.

There are four newly approved Recovery Auditor issues.

This week’s updates include identifying "No Documentation" medical necessity denials for claims flagged for Recovery Auditor review; Shared System Enhancement 2015 Analysis and Design HUOPCUT hospice period and Health Maintenance Organization processing; and more!

Q: If we're not using condition code W2 but we're billing on the type of bill (TOB) 121 after we received a denial, are we paid less than if the W2 would have been used?

Three years after publishing a notice of public rulemaking requiring hospitals to report Medicare overpayments to CMS, the agency finalized a rule that makes significant concessions to providers, but still requires a six-year lookback period.

Q: I was at a conference last week and while we were on a break, I heard someone say that we don’t have to use modifier -L1 (separately payable laboratory test) to get paid for lab work from Medicare. Is that true?

by Valerie A. Rinkle, MPA

There are 10 newly approved Recovery Auditor issues.