decisionhealth Newsletters, Coder Pink Sheets - 2017 Issue 3 (March)
Online only: New drug screens create confusion, typos for carriers
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Article Overview
This article explains how several Medicare contractors were handling updates to drug testing coverage and why that created confusion for practices. It is aimed at coding and billing professionals who need to understand the scope of carrier updates, related coverage documentation, and the general appeal context for denied claims.
Why This Topic Matters
Inconsistent carrier references to updated laboratory testing guidance can lead to denials, appeals, and mismatches between local coverage materials and current fee schedule determinations. The article helps readers identify that the issue is administrative and coverage-related rather than a practice-specific error.
Article Sections
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Carrier confusion over updated drug screening guidance
Summarizes reported inconsistencies among Medicare carriers regarding updated laboratory coverage materials for drug testing and the resulting claim processing issues.
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Appeals and correction notices
Covers the suggested response when denials occur and notes the correction of a typographical issue in carrier guidance.
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Resources
Lists referenced coverage and fee schedule resources for further review.
What You Will Learn
- How carrier coverage materials can lag behind updated laboratory guidance
- Why denial management may require appeal support from current fee schedule determinations
- What kinds of coverage resources are referenced for drug testing updates
- How administrative corrections and typographical issues can affect billing references
Who Should Read This
- Medical coders
- Billing staff
- Laboratory billing specialists
- Compliance personnel
- Practice administrators
Codes Discussed
Code Ranges Discussed
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