Lab test documentation becomes tighter
Lab test documentation becomes tighter
Strict new regulations governing automated laboratory tests allow Medicare carriers to require that physicians 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, 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 taking the following steps to document the medical necessity of screening tests:
• Consider what tests patients need based on 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 to the laboratories on a regular, consistent basis.
The American Medical Association (AMA) and HCFA continue to discuss the issue of automated panels. The AMA would like to establish disease-specific panels that correspond to specific diagnoses. Another option is to eliminate CPT codes for automated panels altogether.
Following are names and telephone numbers of sources quoted in this issue:
• Alta Bates Medical Center, Berkeley; Carol L. Brosgart, MD. Telephone: (510) 204-4444.
• Baylor School of Medicine, Houston; John Kirkland, MD, pediatrician. Telephone: (713) 798-4793.
• Children’s Surgical Associates, Philadelphia; Rocco Mastricola, administrator. Telephone: (215) 977-9507.
• University of Vermont College of Medicine, Burlington; Peter Cherouny, MD, OB/GYN. Telephone: (802) 656-5111.
• Women’s Clinic, Jackson, TN; Bobbye B. Hinson, administrator. Telephone: (901) 422-4642.
• Alice Gosfield and Associates, Philadelphia; Alice Gosfield, JD, president. Telephone: (215) 735-2384.
• American Society of Internal Medicine, Washington, DC; Robert Doherty, associate director, department of federal affairs. Telephone: (202) 835-2746.
• Pennsylvania Medical Society, Harrisburg, PA; Dennis Olmstead, MPA, group director on medical economics. Telephone: (717) 558-7750.
• Physician Payment Review Commission, Chicago; Katie Merrell, senior analyst. Telephone: (773) 702-1877.
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