Clinical lab testing and CLIA get some clarification at Vision Expo

September 19, 2014

hich clinical tests meet clinical laboratory improvement amendments (CLIA) compliance? Furthermore, which routine tests have CLIA waiver approval? If these questions have stumped you, you're not alone, and it's likely you are one of the many who see CLIA as one big mystery.

Las Vegas-Which clinical tests meet clinical laboratory improvement amendments (CLIA) compliance? Furthermore, which routine tests have CLIA waiver approval? If these questions have stumped you, you're not alone, and it's likely you are one of the many who see CLIA as one big mystery.

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To help unravel the mystery, Dr. John Rumpakis, OD, president and CEO of Practice Resource Management provided some tips at Vision Expo West to a room full of competent optometrists and eyecare providers who were looking for a refresher on CLIA and a better understanding of just what it is.

Brought about in 1988 as a way to set standards of quality for laboratory testing, all clinical labs that perform tests on the human body must receive a CLIA certificate of compliance. But that's just the start. And while the topic is multifaceted, Dr. Rumpakis offers these tips:

• CLIA tests must be based on medical necessity. The basis of patient care should be about what the patient truly needs - rather than what the physician wants to bill for.

•  "What is the only thing that can be held against you during an audit?" asks Dr. Rumpakis. "Your medical records. What is the only thing you can use in your defense? Your medical records." Keep air-tight records and your case will be easy when facing an auditor.

• You can't bill the carrier unless there's a specific reason for it. Coverage for services is dependent on the purpose of the exams.

• In general, lab tests are not revenue-generating events for a practice. But with CLIA-waived procedures, it's a different story.

As for the initial questions, while the first would take too much room to fully list, the second is a trick question.

"There is no such thing as a routine clinical exam when it comes to CLIA," Dr. Rumpakis said. "All tests have to be rooted in some sort of patient-based need and not performed automatically." Yes, trick questions still show up on exams.

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