decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Laboratory_Services_Clinical / All_labs_must_now_verify_medical_necessity
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Article Overview
This article addresses a Medicare-related laboratory services issue involving verification of medical necessity for tests ordered by physicians and processed by laboratory providers. It explains the compliance context for POLs and independent clinical laboratories, the role of advance notice to patients when coverage is not expected, and the basis CMS uses to view laboratories as having prior knowledge of Medicare payment policy. The content is relevant to laboratory billing staff, compliance teams, and coding professionals who work with clinical lab reimbursement and coverage policy.
Why This Topic Matters
It helps readers understand a Medicare compliance area that can affect laboratory liability for overpayments and the handling of tests that may not meet coverage requirements.
What You Will Learn
- The Medicare-related compliance issue discussed for laboratory services
- How medical necessity verification is addressed for certain lab settings
- Why patient notice may be relevant when coverage is uncertain
- How CMS views laboratory awareness of Medicare coverage policy
Who Should Read This
- Laboratory billing staff
- Compliance personnel
- Medical coders
- Revenue cycle staff
- Clinical laboratory administrators
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