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The Centers for Medicare & Medicaid Services has published its latest Medicare Quarterly Provider Compliance Newsletter, which provides guidance to address medical billing process errors.

The newsletter is designed to identify common billing errors and other erroneous activities when dealing with the Medicare Fee-For-Service (FFS) Program.

Topics discussed in the January 2017 issue include the following:

  • Retinal photocoagulation
  • Facet joint injection
  • Radiation therapy
  • Stem cell transplants
  • Long-term acute care stays

The newsletter is intended to provide guidance to help health care professionals address and avoid the top issues of the particular quarter.

To access the January 2017 issue, click here.

The Centers for Medicare & Medicaid Services (CMS) recently released an MLN Matters special edition article providing guidance for clinical laboratories about data reporting. The data reporting period opened on January 1.

Here are six things from the article for clinical laboratories to know about data reporting.

1. CMS has developed the online data collection system to assist laboratories in submitting data to CMS, which are due by March 31. A detailed user guide on how to access and use this system is available by clicking here.

2. Laboratories must designate both a Clinical Laboratory Fee Schedule (CLFS) submitter and CLFS certifier in the data collection system. These must be two different individuals. The CLFS submitter must be registered in Medicare's Provider Enrollment, Chain and Ownership System (PECOS) as a "user" or "authorized user" on the PECOS Medicare Enrollment forms (in other words, CLFS submitters must have their name appear within one of the following 855 application forms: A, B, C, I, R). The CLFS certifier does not need to be registered in PECOS.

A data reporting template is available here. Laboratories seeking to upload their data to the CLFS data collection system should use this template.

3. It is advisable to follow the formatting guidelines outlined in the user guide and on the data collection template. The CLFS data collection system will identify formatting errors in your file before you are able to certify the data and submit it. However, for large volumes of data, this process may take several hours to validate. Thus, those files with fewer formatting errors will be processed more efficiently.

4. It is advisable to use the CLFS Applicable Information HCPCS Codes file available here. The system will only accept HCPCS codes listed on this file.

5. The cleaner the file, the smoother the upload process will be.

6. If your laboratory expects to submit over 100,000 lines of data in the .csv template, first contact the CMS/CLFS helpdesk at This email address is being protected from spambots. You need JavaScript enabled to view it. .

Organizations looking for assistance with clinical laboratory billing can contact PGM Billing, a leading, national provider of lab billing services, by calling (877) 857-8981.

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