Page 98 - Medicare Benefit Policy Manual

2. Voluntary withdrawal
3. Laboratory closed, merged with other interests, or organizational change
4. Ownership change with new ownership participating under different name
5. Ownership change with new owner not participating
6. Change in ownership - new provider number assigned
7. Involuntary termination - failure to abide by agreement
8. Former “emergency” hospital now fully participating

80.1.2 - 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. Experience has shown that the failure to inform
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 have to prosecute under a handicap or may simply refuse to
prosecute cases where there is no evidence that a laboratory has been specifically
informed of Medicare regulations and claims processing procedures.

A/B MACs (B) must follow the Provider Education and Training (PET) guidelines to
assure that laboratories are aware of Medicare regulations and the A/B MAC (B’s) policy
when any changes are made in coverage policy or claims processing procedures. The
PET guidelines require A/B MACs (B) to use various methods of communication (such
as print, Internet, face-to-face instruction). Newsletters/bulletins that contain program
and billing information must be produced at least quarterly and posted on the A/B MAC
(B) Web site where duplicate copies may be obtained.

Some items which should be communicated to laboratories and responsibilities that
laboratories are required to perform are:

• The requirements to have the same fee schedule for Medicare and private patients;

• To specify whether the tests are manual or automated;

• To document fully the medical necessity for pickup 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, the representative should prepare and retain reports