Getting paid: Here’s why your drug screen tests were denied: A Medicare claims hold

Why This Topic Matters

Drug screening claims can be denied or delayed if the wrong code set or modifier is used, and payer policies may differ. The article helps billing teams understand why claims may be held, what broad coding changes are involved, and why payer follow-up matters.

Article Sections

1. Medicare claims hold and system issue

   Explains a temporary Medicare processing problem affecting drug screen claims and the related timing of claim adjudication changes.

2. Select new codes based on type of test

   Introduces the 2016 drug screen code changes and compares broad categories of test methodology used for code selection.

3. Expect to see pay drop in 2016

   Discusses general payment changes associated with the updated drug screen code structure and bundled components.

4. Definitive test coding is class based

   Covers the distinction between definitive testing and other drug testing approaches, including class-based reporting concepts.

5. Watch your private payers

   Reviews payer variability and the need to verify which drug testing code set different insurers are using.