Lab Management Lesson 5

Lab Management Lesson 5

• 1983: Prospective Payment System (PPS): Medicare patient payments based on Diagnosis-Related Groups (DRGs). Hospitals receive a fixed amount per DRG.

• 1984: Deficit Reduction Act: Established outpatient lab fees for cost control.

• 1989: Physician Self-Referral Ban: Prevents physicians from referring Medicare patients to self-owned labs.

• 1990: Three-Day Rule: Lab testing done within three days of admission is not reimbursable.

• 1992: Occupational Exposure to Bloodborne Pathogens: OSHA guidelines to limit exposure via proper procedures.

• 1996: Health Insurance Portability and Accountability Act (HIPAA): Protects patient information and access to Protected Health Information (PHI).

• 1997: OIG Compliance Guidelines: Help labs develop ethical and legal conduct programs.

Regulations and Policies

• 2001: CMS National Coverage Determinations: Replaced local medical review policies for lab testing, determining medical necessity.

• 2003: Hazardous Materials Regulations: Covers hazardous substances like blood and their potentially hazardous products.

• 2007: Health Information Technology for Economic and Clinical Health (HITECH) Act: Encourages adoption of electronic health records (EHRs), providing patient access to Protected Health Information (PHI) within 30 days.

Laboratory-Related Governmental Agencies

• Centers for Medicare & Medicaid Services (CMS): Largest healthcare programs in the U.S.

• Centers for Disease Control and Prevention (CDC): Public health safety.

Other Agencies

• Environmental Protection Agency (EPA): Enforces hazardous lab material disposal standards.

• Equal Employment Opportunity Commission (EEOC): Fair employment practices.

• Food and Drug Administration (FDA): Regulates and manufactures biologics, medical devices, and test kits.

• Department of Health & Human Services: Oversees relevant agencies such as CMS, OIG, and FDA.

• National Archives and Records Administration (NARA): Provides databases and access to the federal register.

• Nuclear Regulatory Commission (NRC): Enforces federal guidelines for non-military nuclear facilities.

• National Institute on Drug Abuse (NIDA): Performing and maintaining quality control for drug abuse testing.

• National Institute for Occupational Safety and Health (NIOSH): Provides research, information, education, and training in occupational safety and health.

• National Institutes of Health (NIH): A world leader in medical research.

• National Institute of Standards and Technology (NIST): Contributes to the development of healthcare products.

• Office of Inspector General (OIG): Audits, inspects, and identifies fraud and abuse in CMS programs.

• Occupational Safety and Health Administration (OSHA): Develops and enforces workplace safety standards.

• Department of Homeland Security (DHS): Identifies, regulates, and may inspect high-risk chemical facilities.

• American Association of Blood Banks (AABB): Blood bank accreditation.

• American Society for Clinical Pathology (ASCP): Largest organization for laboratory professionals, offers certifications.

• College of American Pathologists (CAP): Offers the largest proficiency program in the U.S.

Clinical and Laboratory Standards Institute (CLSI)

• Develops standardized criteria for lab practices.

Commission on Office Laboratory Accreditation (COLA)

• Nonprofit organization providing assistance to physician office labs.

Joint Commission (TJC)

• Nonprofit organization accrediting healthcare organizations and programs.

National Laboratories

• Government-designated labs providing specialized services.

Research Institute for Tropical Medicine

• Microbiology, parasitology, mycology, virology research.

Explore key regulations and policies that have shaped lab management from 1983 to 2001. This quiz covers significant acts including the Prospective Payment System, HIPAA, and guidelines for ethical conduct in labs. Test your knowledge on the impacts of these legislative changes on healthcare delivery.