decisionhealth Newsletters, Part B News - 2025 Issue 4 (April)
Lab tests score poorly on CERT; use protocols, EHR to beat the spread
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Article Overview
This article reviews why certain laboratory test claims are vulnerable in Medicare post-payment review and summarizes documentation-focused guidance from CMS and related contractors. It is aimed at billing teams, coding professionals, compliance staff, and providers who manage lab orders, EHR workflows, and medical necessity documentation. The discussion covers CERT data trends, laboratory service documentation expectations, ordering physician attestation, verbal-order documentation, and internal audit and template strategies for reducing risk.
Why This Topic Matters
Laboratory claims can be paid and later overturned if the supporting record is incomplete or inconsistent. Understanding the documentation and workflow issues discussed here can help practices improve compliance and prepare for Medicare review.
Article Sections
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CERT findings and lab claim risk
Summarizes recent Medicare improper payment findings involving laboratory services and explains the general review context for paid claims.
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Get it in writing
Focuses on documentation expectations for laboratory orders and the types of record support CMS expects to see.
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Program your EHR
Discusses workflow and EHR template considerations, along with internal audit and training approaches for lab ordering documentation.
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Watch 3 other trouble spots
Reviews additional documentation and ordering issues related to physician attestation, verbal orders, and follow-through on test results.
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Resources
Lists CMS and contractor reference materials cited in the article.
What You Will Learn
- How CERT findings highlight documentation-related risk for laboratory claims
- What types of record support are discussed for lab orders and test reporting
- Why EHR design and internal audits matter for lab documentation compliance
- Which ordering and attestation issues can create problems in Medicare review
- How follow-up documentation fits into lab test compliance workflows
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
- Physicians and ordering providers
- Clinical documentation specialists
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