End of commissions on lab sales

[AZpath]

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Congress Expands Anti-Kickback Statute to Include All Payors for Laboratories, Clinical Treatment Facilities, and Recovery Homes

This EKRA law is interesting.
Would it shut down client billing for AP?
So far I have not seen this mentioned.

 

[WEBB PINKERTON]

I was wondering the same thing. It is extremely confusing.

 

[LADoc00]

Yah this kills client billing for everything if the client is bumping up the cost AT ALL.

This is already illegal in CA, now is pretty much nationwide. The exceptions are spelled out and very limited:
EKRA provides several exceptions that protect certain arrangements, specifically:

• A properly disclosed and notated discount or other reduction in price under a healthcare benefit program
  
  
• Payments to an employee or independent contractor that do not vary based on the number of individuals referred, the number of tests or procedures performed, or the amount billed to or reimbursed from a health care benefit program
  
  
• Drug discounts under the Medicare coverage gap discount program
  
  
• Payments made in compliance with the federal Anti-Kickback Statute’s personal services and management contracts safe harbor
  
  
• Non-routine, good-faith waivers or discounts of any coinsurance or copayment amount
  
  
• Arrangements with health center entities that serve medically underserved populations care if designed to increase availability or quality of services provided
  
  
• Alternative payment model payments or payments under an arrangement used by a state, health insurance issuer, or group health plan, if HHS determines it necessary for care-coordination or value-based care.
  
  
• One important distinction between the EKRA exceptions and the federal Anti-Kickback Statute’s safe harbors is the absence of the Anti-Kickback Statute’s employment safe harbor under EKRA. This means that previously compliant payment methodologies structured under the Anti-Kickback Statute’s employment safe harbor (such as paying W-2 employees a volume or value based commission) are now at risk of violating EKRA.
  

 

[AZpath]

In our state client billing on AP path is outlawed. I think you can still purchase and mark up CP tests.

Most of the legal writing has been on commissioned lab sales. I don't have any sales people.

 

[LADoc00]

In our state client billing on AP path is outlawed. I think you can still purchase and mark up CP tests.

Most of the legal writing has been on commissioned lab sales. I don't have any sales people.

Not sure about this, how would buying a CBC for 4 bucks a pop and selling it for double without performing any of the actual testing NOT be a kickback? Literally a direct kickback of 4 dollars per test. I know this because here in California where it is illegal at a state level, I cannot bill for reference lab testing beyond what the reference lab charges me, under any circumstance.

 

[WEBB PINKERTON]

Most of the state laws only protect AP from client billing schemes. Before the law was enacted in my state, the going rate for skins was less than 10 bucks. Paps were around 18 bucks. Client billing has always seemed like a kickback to me. Some of the stuff we have to do to get business walks a fine line between legal and illegal. I am just glad I have never been to prison. I don't think I would do well in a Kentucky prison.

It is still the wild west with CP. I have noticed less CP client billing in my area due to physician office's being part of health systems now. Our health system ended the practice a year or two ago on CP.

It is hard to blame the government for passing PAMA when you see labs doing work for virtually below cost just to have the medicare work.

 

[LADoc00]

I can tell you with 100% certainty that client marking up either CP or AP in California is illegal. Notice I do NOT say client billing is illegal, only the marking up part.

Now do small offices do it to make an extra buck here and there? Yes. And if they are caught in a RAC audit billing CMS, they are deleted...

Guess you have decide for yourself as a clinician is the "juice worth the squeeze".

 

[WEBB PINKERTON]

Looks like Florida, Michigan, Oregon and California prevent marking up. It is a reality for the rest of us. Not sure how much has changed since this was published.

http://uscapknowledgehub.org/site~/96th/pdf/companion21h02.pdf

I like how there are states that allow markups as long as the physician office discloses what they paid. Tennessee even defined the minimum font size. lol

I noticed Jane Pine Wood took a job with bioreference labs/opko. Wonder how she is enjoying that.

 

[AZpath]

It is Bioreference/Opko that is going to be unhappy. She will make them follow the law😉

 

[WEBB PINKERTON]

If Street Sweeper was accurate in those articles they wrote years ago, she had a job ahead of her.

That lab used to be a player in my area years ago but they aren't anymore. Labcorp and Quest likely aren't concerned about them.

I like the title of her presentation "How to Compete when everyone is cheating". That pretty much sums up pathology and should make anyone considering this field run away.

 

[CDX-2]

Most of the state laws only protect AP from client billing schemes. Before the law was enacted in my state, the going rate for skins was less than 10 bucks. Paps were around 18 bucks. Client billing has always seemed like a kickback to me. Some of the stuff we have to do to get business walks a fine line between legal and illegal. I am just glad I have never been to prison. I don't think I would do well in a Kentucky prison.

It is still the wild west with CP. I have noticed less CP client billing in my area due to physician office's being part of health systems now. Our health system ended the practice a year or two ago on CP.

It is hard to blame the government for passing PAMA when you see labs doing work for virtually below cost just to have the medicare work.

$10??!! How much are skins worth now?!?!

It sounds like retail is more profitable than pathology!

 

[WEBB PINKERTON]

$10??!! How much are skins worth now?!?!

It sounds like retail is more profitable than pathology!

Client billing is gone so no more of that.

Of course many of the derms now have an in-office lab or they sold out to Forefront derm and their biopsies go to Forefront's lab in Wisconsin.

Derm is a dirty business. We lost virtually all of our derm work a decade ago and it was a major volume loss.

 

[deleted314957]

In my perception, derm path required more ass kissing, etc.in order
to retain/expand ones business book. I never had to directly deal with it.
We did have derm path folks, however, who did. I found it much easier
to keep a hospital medical staff and admin pleased than dealing with the derm vipers.