Of the five, Certificates of Waiver have the most frequent changes to the tests certified labs can perform. This is because physician groups frequently request that CMS review and re-classify tests so that they may be performed by waiver-certified facilities. Once new “waived” tests are approved, CMS should immediately contact its contractors to ensure proper claim processing, but sometimes this communication is delayed.
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Physicians who send lab tests out for processing should know which tests require only a waiver-certified laboratory; CMS contractors may not be aware of changes and may initially deny a claim for a recently re-evaluated test sent to such a lab. If a physician is well informed, he or she can appeal such denials and have a better chance of success. Physicians who have in-office “waiver-certified” laboratories should also be aware of new tests and procedures their lab can perform.
Because the list of tests that can be performed at Certificate of Waiver–certified labs changes frequently, physicians should monitor it on a monthly or quarterly basis. Visit www.cms.hhs.gov/transmittals/downloads/R1195CP.pdf for more information