The College of American Pathologists (CAP) has assembled a collection of key regulatory and compliance matters for pathologists and their laboratories. These member-only documents are available to download for your use. You can start with these key terms pathologists and laboratory administrators may encounter when tackling these regulatory compliance issues.
Advanced Beneficiary Notice
Medicare allows providers to obtain reimbursement directly from beneficiaries for certain services if the beneficiary has received and signed a timely and proper Advanced Beneficiary Notice (ABN). An ABN is to be used only when an item or service is to be furnished by a provider that the provider believes Medicare probably or certainly will not pay due to lack of medical reasonableness and necessity, or non-coverage.
Medicare Reassignment Rule
The Medicare Reassignment Rule provides exceptions to the general rule that Medicare will only pay the beneficiary, or the physician or supplier who furnishes services for a covered beneficiary. The Medicare Reassignment Rule allows a physician or group to bill for the work of another physician or supplier if they satisfy the requirements of one of the exceptions. The Medicare Reassignment Rule is enforced by the Centers for Medicare and Medicaid Services.
Part A Compensation
Because reimbursement under Part A is made directly to the hospital, the pathologist or pathology group responsible for the management and supervision of the laboratory must seek payment from the hospital.
The CAP has created information packages detailing Medicare Part A and billing the professional component of Medicare services.
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