Over the past 18 months, the Louisiana Department of Health, under the leadership of the new administration, has taken several actions to improve its laboratory claims payment system.

The Department has implemented an automatic monitoring system which ensures Medicaid claims payments are made only to labs with proper Clinical Laboratory Improvement Amendments (CLIA) certification.

“When this administration came on board, we discovered that in spite of Medicaid policy, some labs that were being used by clinics, nursing homes, hospitals and other providers did not have the proper certifications. Certification ensures that a lab meets the highest standards for clinical accuracy,” said Jen Steele, Medicaid Director for the Department of Health.

Steele said Medicaid now has an automated system in place that, on a weekly basis, compares its list of lab service providers against the CLIA database to check for the CLIA certification.

The Department of Health also has these steps in place to ensure payments are not made to non-certified labs. These include:

  • Annually, the Louisiana Department of Health evaluates the CMS fee schedule (procedure codes) for laboratory services. When new codes are added or old codes removed, the Medicaid payment system is updated, and claims are not paid for removed codes.
  • The department also monitors and reviews the lab payment process of its claims contractor, Molina, to ensure they contain up-to-date procedure codes for lab tests.
  • The internal improvements taken by the department are also being applied to its five managed care health plans which pay claims for laboratory services.

Laboratory certification standards are designed to confirm that lab results are accurate and that lab staff have the necessary training and experience.

Improvement actions taken by the Department of Health are outlined in the department’s response to a recent report from the Legislative Auditor.

 

The Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state residents. To learn more about LDH, visit www.ldh.la.gov. For up-to-date health information, news and emergency updates, follow LDH's Twitter account, Facebook and blog.