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IMPORTANT NOTICE: CMS is late in posting the following updates for 1/1/26: OPPS, APC, ASC.
We will update this site as soon as files are posted.
Free Webinar: The Outlook for Medicare CLFS Rates
CodeMap® Compliance Briefing: August 18, 2017
Editor's Welcome:
Recently, we have received multiple email inquires concerning Medicare's direct billing rules. I reviewed our CodeMap® Compliance Briefing Library and discovered we have not covered this topic in nearly 8 years. Based on the number of inquiries and the time that has lapsed since our last discussion, we have determined that a review of Medicare's direct billing rules is long overdue. We will discuss these rules over the next 2 weeks. This week we will discuss basic rules and relevant exceptions that apply to clinical laboratories, especially the "70/30" rule. Subsequently, next week, we will discuss how these rules apply to hospital outpatients and nonpatients, as well as review the requirements concerni....
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