Federal regulations: compliance and implications. 1997

L J San Diego
Health Care Management Development Center, Clinton Twp., MI 48038, USA.

The Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) are still an evolving process just as they were when formally launched in September 1992. In developing and guiding CLIA '88 programs, the Health and Human Services relied on 2 key agencies; the Health Care Financing Administration, and the Centers for Disease Control and Prevention within the Public Health Service. CLIA '88 established an important key position for laboratory personnel: the consultant with technical and scientific oversight of moderate complexity test performance, who also consults with laboratory clientele regarding diagnosis, treatment, and management of patient care, including the appropriateness of test(s) ordered. With these responsibilities, it is imperative for consultants and laboratory managers to thoroughly understand regulatory issues in consulting to determine the fine line between what is legal and what is not, and to ascertain any fraudulent and abusive over-utilization of laboratory services and claims under government health care programs. Current federal regulatory policies that clinical laboratory practitioners must be aware of and comply with will be discussed in this article.

UI MeSH Term Description Entries
D007349 Insurance, Health, Reimbursement Payment by a third-party payer in a sum equal to the amount expended by a health care provider or facility for health services rendered to an insured or program beneficiary. (From Facts on File Dictionary of Health Care Management, 1988) Health Insurance Reimbursement,Reimbursement, Health Insurance,Third-Party Payments,Third-Party Payers,Health Insurance Reimbursements,Insurance Reimbursement, Health,Insurance Reimbursements, Health,Payer, Third-Party,Payers, Third-Party,Payment, Third-Party,Payments, Third-Party,Reimbursements, Health Insurance,Third Party Payers,Third Party Payments,Third-Party Payer,Third-Party Payment
D007753 Laboratories Facilities equipped to carry out investigative procedures. Laboratory
D003253 Consultants Individuals referred to for expert or professional advice or services. Advisory Services,Services, Advisory,Advisory Service,Consultant,Service, Advisory
D005161 Facility Regulation and Control Formal voluntary or governmental procedures and standards required of hospitals and health or other facilities to improve operating efficiency, and for the protection of the consumer. Facility Control,Facility Regulation,Regulation, Facility,Control, Facility,Controls, Facility,Facility Controls,Facility Regulations,Regulations, Facility
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014481 United States A country in NORTH AMERICA between CANADA and MEXICO.
D018584 Physician Self-Referral Referral by physicians to testing or treatment facilities in which they have financial interest. The practice is regulated by the Ethics in Patient Referrals Act of 1989. Self-Referral, Physician,Physician Self Referral,Physician Self-Referrals,Self Referral, Physician,Self-Referrals, Physician
D019983 Guideline Adherence Conformity in fulfilling or following official, recognized, or institutional requirements, guidelines, recommendations, protocols, pathways, or other standards. Institutional Adherence,Policy Compliance,Protocol Compliance,Adherence, Guideline,Adherence, Institutional,Compliance, Policy,Compliance, Protocol

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