Training Programs
Audits & Assessments
Regulatory MonitoringNov
20
Tip: Submission of claims for laboratory services
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A hospital should ensure all claims for clinical and diagnostic laboratory testing services are accurate and correctly identify the services ordered by the physician (or other authorized requestor) and performed by the laboratory. The OIG recommends a hospital’s written policies and procedures require:
- The hospital bill for laboratory services only after they are performed
- The hospital bill only for medically necessary services
- The hospital bill only for tests actually ordered by a physician and provided by the hospital laboratory
- The CPT or HCPCS code used by the billing staff accurately describe the service ordered
- The coding staff only submit diagnostic information obtained from qualified personnel
- The coding staff contact the appropriate personnel to obtain diagnostic information when the individual who ordered the test has failed to provide such information
- The hospital document receipt of diagnostic information obtained from a physician or the physician’s staff after receiving the specimen and request for services
- The hospital conduct routine audits to assess billing compliance with the regulations
This tip was adapted from The Compliance Officer’s Handbook. For more information about the book or to order your copy, click here.
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