decisionhealth Newsletters, Part B News - 2022 Issue 2 (February)
Urine drug testing settlements signal suspicious coding, documentation patterns
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Article Overview
This article examines settlement allegations brought by state and federal authorities concerning urine drug testing billing patterns in medical practices. It is aimed at coders, compliance staff, auditors, and practice leaders who need to understand how documentation and ordering workflows can affect medical necessity, claim scrutiny, and settlement risk. The discussion highlights general warning signs, chart review issues, and examples involving multiple practices without providing premium-level coding guidance.
Why This Topic Matters
Urine drug testing is a high-scrutiny service area, and patterns in ordering, documentation, and billing can trigger audits, investigations, and settlements. Understanding the broad compliance themes helps practices identify risk in their own workflows and documentation processes.
Article Sections
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Billing
Introduces the enforcement focus on urine drug testing claims and summarizes the broad allegations seen in recent settlements.
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Review charts, missed signs
Discusses why claim patterns and chart documentation may signal potential problems and presents several settlement-based examples.
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Case number one
Covers the first example of alleged billing and documentation concerns involving recurring urine drug testing patterns.
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Case number two
Covers a second example involving outside laboratory testing, internal ordering practices, and related documentation concerns.
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Resources
Lists settlement announcements and related reference links cited by the article.
What You Will Learn
- How settlement allegations can reveal recurring compliance issues in urine drug testing billing
- What broad documentation and ordering patterns may prompt chart review
- How government enforcement actions can relate to medical necessity and claim submission concerns
- Why workflow consistency matters in practices that perform both presumptive and definitive testing
Who Should Read This
- Medical coders
- Compliance officers
- Billing staff
- Practice administrators
- Auditors
- Healthcare attorneys
- Pain management and addiction medicine practices
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