Lab test documentation becomes tighter

Strict new regulations governing automated laboratory tests allow Medicare carriers to require that physicians to document the medical necessity of tests they order.

In the past, if only one or two tests in a panel were documented as being medically necessary, the Health Care Financing Administration (HCFA) would reimburse for the entire panel. But that fostered overutilization, fraud, and abuse of laboratory tests, HCFA officials say. Now, HCFA officials expect that greater vigilance in reviewing the medical necessity of some panel tests will eliminate these abuses.

In addition, new technology now makes it possible to perform individual tests that were cumbersome in the past under automated laboratory technology. Experts recommend the following steps to document the medical necessity of screening tests:

• Consider what tests patients need in light of the symptoms displayed, and order only those tests.

• Document in the patient’s record what the symptoms were and what tests were ordered.

• Provide diagnosis information on a regular, consistent basis to the laboratories.