Clinical Laboratory

Clinical Laboratories perform a critical function in the healthcare marketplace, and when in-house can generate valuable revenue for hospitals, health systems and other providers. As the regulatory and reimbursement landscape evolves it is essential laboratories to stay current to comply with law and maintain their licenses and accreditations, while providing quality services and generating the most value possible. Granite GRC’s professionals partner with clinical laboratories to improve their success through efficient and effective laboratory operations, strong reimbursement and consistent compliance.

Addressing Needs and Challenges

Granite GRC utilizes consultants with diverse backgrounds and real world, hands-on experience in the laboratory field, including clinical laboratory operations and compliance in large hospital systems, niche genetics laboratories, and full service independent commercial laboratories with the most complex test menus. Our seasoned professionals help clients navigate the impact of operational decisions on compliance and the impact of compliance initiatives on operations.

• Documentation, coding and billing assessments
• Chargemaster CPT/HCPCS code assessments
• Test utilization and pricing analyses
• Risk assessment/management
• Laboratory licensing and accreditation
• Compliance and privacy program assessments and improvements
• Coaching, consulting, part time and interim compliance and privacy officers

Products & Services

Documentation, Coding and Billing Assessments

Review claims throughout the revenue cycle including documentation of:

• Order by the physician or other authorized ordering provider
• Registration in the Laboratory Information System (LIS) and check for medical necessity
• Result reporting
• Coding
• Billing and reimbursement

Chargemaster CPT/HCPCS Code Assessments

• Assess codes the laboratory has assigned to individual tests, panels and profiles
• Reviews may be triggered by internal policies requiring periodic audits of the entire test menu, published code updates
  (e.g., AMA, CMS), ongoing changes to the laboratory’s test menu, or at the request of management in response
  to industry enforcement actions

Test Utilization and Pricing Analyses

• Periodic reviews of ordering patterns and pricing structure

Risk Assessment/Management

• Assist laboratories in assessing and mitigating identified risks, such as:
  -Billing/coding errors
  -Lack of medical necessity
  -Improper arrangements with marketing firms, consultants, or referral sources
  -Reference laboratory arrangements (e.g., fraudulent telemedicine orders)
  -Eliminating Kickbacks in Recovery Act (EKRA), compensation arrangements with sales and marketing
  personnel, and understanding the key similarities and differences from the AKS andStark Law
•  Establish or evaluate risk management programs

Laboratory Licensing and Accreditation

• Accreditation gap analysis (PA DOH, CLIA, CAP, TJC)
• Guidance on applications and changes to CLIA certificates, PA laboratory permits, and CAP/TJC accreditations
• Evaluation of personnel qualifications
• Assistance developing responses to inspection deficiencies
• Review test requisitions and reports

Compliance and Privacy Program Assessments and Improvements

• Assess laboratory compliance programs for alignment with key guidance documents including the OIG Program
  Guidance for Clinical Laboratories and the DOJ Evaluation of Corporate Compliance Programs
• Coaching, consulting, part time and interim compliance and privacy officers