Recovery audit issues: Review drug screenings claims in preparation for new RAC audit

Why This Topic Matters

Urine drug screening claims are being targeted for audit scrutiny, and practices that bill these services need to understand the broader Medicare policy framework affecting claim submission, laboratory certification, and modifier use. The article helps readers identify whether their workflow involves the types of testing and compliance issues under review.

Article Sections

1. RAC audit focus on urine drug screening claims

   Introduces the audit concern and the Medicare contractors involved. It frames the article around claim review risk for practices that regularly submit urine testing services.

2. CMS policy background and claim submission concerns

   Summarizes the policy changes and documentation concerns that led to questions about reporting multiple tests. It also references related Medicare manual guidance.

3. Reporting guidance for CLIA-related urine drug screening services

   Covers general coverage and reporting topics for laboratory testing performed under CLIA, including waived and higher-complexity testing contexts. It also references modifier and certification-related issues.

4. CLIA waiver and laboratory certification requirements

   Describes the administrative requirements associated with performing urine drug screens under a waiver. It discusses the need for certification and renewal at the practice location level.