Corporate Compliance

Tip: Submission of claims for laboratory services

Compliance Monitor, November 19, 2008

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 current procedural terminology (CPT) or Healthcare Common Procedural Coding System (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.


1 comments on “Tip: Submission of claims for laboratory services

laboratory billing (4/2/2012 at 8:33 AM)
All laboratory claims must include the NPI number of the referring physician, in addition to the other elements of a Complete Claim described in this Guide... Laboratory claims that do not include the identity of the referring physician will be rejected or denied... <a href="">laboratory billing</a>


Most Popular