Compliance

Print Compliance Letter (pdf)

As an integral part of Newton-Wellesley Hospital’s (NWH) Laboratory Compliance Program, we are providing you with our annual notice to all ordering providers. Our goal is to process the right test, for the right reason and for the right patient based on valid lab orders submitted by the authorized provider.

The contents of this notice are based on recommendations from the Office of the Inspector General (OIG) that explain ordering providers’ obligations under Federally funded programs. The NWH Laboratory relies on you to ensure the following key elements are documented when we perform the ordered test(s):

1. The information submitted on the laboratory requisition accurately reflects the medical reasons (specific patient diagnosis) for requesting each laboratory test.
2. The medical necessity for each individual test ordered has been documented in the patient’s medical record.
3. When you order tests for purposes of screening asymptomatic conditions, you have advised the patient that corresponding payment may be denied by Medicare or other payers. The requisition, in such case(s) should note that the test is for screening purposes, and include the reason(s) for visit/diagnosis.
4. You agree to cooperate with audits which may be conducted by the hospital to review and verify the accuracy of information submitted to the laboratory.

Thank you for your ongoing cooperation with the implementation of the NWH Laboratory Supplemental Requisition program which was launched in June 2012. By responding to our queries for additional information on laboratory requisitions, NWH Laboratory is able to submit complete and accurate laboratory claims in a timely manner.

Please refer to the following two sections that address NWH guidelines for laboratory services:

1. Guidelines for Laboratory Billing Compliance, which includes the required documentation on NWH Laboratory Requisitions to comply with the OIG recommendations
    
2. List of NWH Laboratory’s CMS-approved test panels and their components.

Anthony J. Guidi, MD, Chair of Pathology, is the CLIA Laboratory Clinical Consultant and can be reached at 617-243-6234 for any further questions.

For a copy of the Medicare Laboratory Fee Schedule for Massachusetts, please contact Bob Page, Directory of Laboratory and Surgical Pathology, at 617-243-6772.

If you have any questions or concerns about this annual notice or other issues related to NWH Laboratory Compliance, please do not hesitate to contact any one of us as listed below:
Martha Pyle Farrell, NWH Compliance Officer, email or 617-243-6487
Margaret Fisher, NWH Billing Compliance Manager, email or 617-243-5248
Hemali S. Patel, Laboratory Compliance Officer, email or 617-243-6285

Thank you for your continued support to help meet the OIG recommendations for Laboratory Compliance.