What action will Medicare take if alerted about an expired certificate in a physician's office lab?

If Medicare is alerted about an expired certificate in a physician's office lab, it will typically deny claims associated with that lab. This action reflects Medicare's stringent compliance requirements regarding laboratory services, which include the necessity for all laboratories to maintain valid certifications to ensure quality care and accurate laboratory testing.

An expired certificate indicates that the lab is not currently compliant with Medicare’s operational standards, meaning that any claims submitted for services rendered by that lab cannot be reimbursed. This protects the integrity of the Medicare program and ensures that beneficiaries receive services from certified and compliant providers.

In contrast, other possible actions like approving claims with a warning, requesting additional information, or providing emergency coverage do not align with the strict regulatory framework in place for lab certifications. Medicare’s policies prioritize compliance, and allowing claims to be submitted without valid certifications would undermine that goal.