Corporate Compliance

Tip: Submitting claims for laboratory services

Compliance Monitor, November 18, 2009

Your hospital should ensure that 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 that your hospital’s written policies and procedures state that:
  • 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 or Healthcare Common Procedural Coding System code used by the billing staff accurately describes the service ordered
  • The coding staff submit only diagnostic information obtained from qualified personnel and contact the appropriate personnel to obtain diagnostic information in the event that 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
  • Routine audits be conducted to assess your billing compliance with the regulations
This week’s tip was adapted from The Compliance Officer’s Handbook 2nd Edition. For more information about the book or to order your copy, visit the HCMarketplace.

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