Laboratory Question for the Week of November 21, 2016

Laboratory Compliance Question of the Week

Question:

Do you know what lab test has the highest number of billing errors?

Answer:

According to the Centers for Medicare & Medicaid Services (CMS), in 2015, laboratory tests, including urine drug screenings, had an improper Medicare payment rate of 39 percent and accounted for a projected $1.2 billion in Medicare fee-for-service improper payments. Most of these improper payments were due to insufficient documentation, according to a CMS report.

In “Provider Compliance Tips for Laboratory Tests—Other—Urine Drug Screening,” CMS explains that claims are denied when the documentation does not support the intent to order the test and/or the medical necessity for the test. Another common reason is that the treating physician or non-physician practitioner fails to sign the medical record documentation.

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.