Corporate Compliance

Tip: Submission of claims for laboratory services

Compliance Monitor, October 6, 2010

A hospital should ensure that all claims for clinical and diagnostic laboratory testing services are accurate and that they correctly identify the services ordered by the physicians (or other authorized requestor) and performed by the laboratory. The OIG recommends that a 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 those tests actually ordered by a physicians and provided by the hospital laboratory
  • The current procedural terminology or Healthcare Common Procedural Coding System code used by the billing staff accurately describe the service that was ordered
  • The coding staff submit only diagnostic information obtained from qualified personnel and contact the appropriate to obtain diagnostic information in the event that the individual who ordered the test 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. For more information about the book or to order your copy, visit the HCMarketplace.

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