Notices to physicians
CMS recommends that clinical laboratories provide all of their physician clients with annual written notices that state:
- the Medicare national policy and Medicare contractor local medical review policy for lab tests;
- that organ or disease related panels will only be paid and will only be billed when all components are medically necessary;
- the Medicare laboratory fee schedule and a statement informing the physician that the Medicaid reimbursement amount will be equal to or less than the amount of Medicare reimbursement.
In addition to the general notices above, laboratories that continue to offer customized profiles should provide annual written notices that:
- Explain the Medicare reimbursement paid for each component of each such profile;
- inform physicians that using a customized profile may result in the ordering of tests which are not covered, reasonable or necessary and that tests will not be billed; and
- inform physicians that the OIG takes the position that an individual who knowingly causes a false claim to be submitted may be subject to sanctions or remedies available under civil, criminal and administrative law.
CMS also recommends that physicians using customized panels sign acknowledgments stating they understand the potential implications of ordering customized panels.