decisionhealth Newsletters, Part B News - 2017 Issue 4 (April)
Lab-code denial rates may augur increased scrutiny from auditors
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Article Overview
This article summarizes CMS improper-payment findings and denial-rate patterns for commonly billed laboratory services, including glucose monitoring, urinalysis, blood counts, cultures, and venipuncture. It is aimed at coding, compliance, and billing professionals who want a high-level view of audit exposure and the broad areas of lab coding under increased review.
Why This Topic Matters
Laboratory services are high-volume claims areas, so even modest documentation or billing issues can create significant payment risk. The article helps readers understand which broad lab service categories are drawing attention from CMS data and why those trends matter for compliance monitoring.
What You Will Learn
- Which broad laboratory service categories are highlighted in CMS improper-payment data
- How denial-rate trends can differ from improper-payment rates
- Why laboratory claims may face increased audit attention
- What types of lab services are commonly represented in national claims data
Who Should Read This
- Medical coders
- Billing professionals
- Compliance staff
- Revenue cycle teams
- Audit and compliance analysts
Codes Discussed
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