Practice Management Alert

CLIA 101: The Clinical Laboratory Improvement Amendments (CLIA) affects all laboratories and any practice that has an in-office lab - no matter how small. CLIA establishes three categories of lab tests: waived, moderate complexity, and high complexity. Small, in-office labs commonly have a certificate of waiver that allows them to perform and bill only waived tests.
 
 1. Know the list: If your practice has a waived lab, you should be familiar with the list of CLIA-waived tests (accessible online at www.cms.hhs.gov/clia/waivetbl.pdf) so you know which tests you can bill Medicare for and which tests your lab personnel will send out to a reference lab, says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore. Otherwise you may inappropriately bill for a test your practice is not allowed to perform.
 
 2. Append modifier -QW: Every CLIA-waived test code is listed twice on the Medicare fee schedule - once by itself and once with the -QW modifier to indicate the test is CLIA-waived. If your office has a waived lab, you must add modifier -QW (CLIA-waived test) to every waived lab test you report, Dettwyler says. This modifier tells Medicare your practice has CLIA-waived status and is allowed to bill for the lab code you are reporting.  3. Don't get tricky: You can't just append modifier -QW to any lab code and expect to get paid, Dettwyler says. The code you report must be listed on the fee schedule with -QW.