Keeping current on changes to laboratory certifications for common lab tests can save your practice time—and money. Since the passage of the Clinical Laboratory Improvement Amendments (CLIA) in 1988, all health-assessment laboratory tests are ranked for complexity, and their complexity dictates which labs can process Centers for Medicare and Medicaid Services (CMS)–reimbursed tests. In accordance with CLIA, each laboratory facility must register with CMS to receive a CLIA certification. There are five certifications, each with differing degrees of complexity, listed from least to most complex: Certificate of Waiver, Certificate of Provider-Performed Microscopy Procedures, Certificate of Registration, Certificate of Compliance, and the Certificate of Accreditation.
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.
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