A/B MAC (B) Contacts With Independent Clinical Laboratories

110.4 - A/B MAC (B) Contacts With Independent Clinical Laboratories (Rev. 1, 10-01-03) B3-2070.1.F An important role of the A/B MAC (B) is as a communicant of necessary information to independent clinical laboratories. Failure to inform independent laboratories of Medicare regulations and claims processing procedures may have an adverse effect on prosecution of laboratories suspected of fraudulent activities with respect to tests performed by, or billed on behalf of, independent laboratories. United States Attorneys often must prosecute under a handicap or may refuse to prosecute cases where there is no evidence that a laboratory has been specifically informed of Medicare regulations and claims processing procedures. To assure that laboratories are aware of Medicare regulations and A/B MAC (B)’s policy, notification must be sent to independent laboratories when any changes are made in coverage policy or claims processing procedures. Additionally, to completely document efforts to fully inform independent laboratories of Medicare policy and the laboratory’s responsibilities, previously issued newsletters should be periodically re-issued to remind laboratories of existing requirements. Some items which should be discussed are the requirements to have the same charges for Medicare and private patients, to document fully the medical necessity for collection of specimens from a skilled nursing facility or a beneficiary’s home, and, in cases when a laboratory service is referred from one independent laboratory to another independent laboratory, to identify the laboratory actually performing the test. Additionally, when A/B MAC (B) professional relations representatives make personal contacts with particular laboratories, they should prepare and retain reports of contact indicating dates, persons present, and issues discussed.