Laboratory Question for the Week of December 19, 2016

Laboratory Compliance Question of the Week


What kind of documentation is requested for medical reviews of claims for lab tests?


According to the Centers for Medicare & Medicaid Services (CMS), examples of documentation that may be requested for medical review of claims for laboratory tests, including urine drug screenings include:

  • Clinical evaluations, physician evaluations, consultations, progress notes, physician’s office records, hospital records, nursing home records, home health agency records, records from other healthcare professionals and test reports. This documentation is     maintained by the physician and/or provider.
  • Supplier/laboratory notes include all documents that are submitted by suppliers and laboratories in support of the claim.
  • Other documents include any records needed from a biller in order to conduct a review and reach a conclusion about the claim.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.