Saturday, August 20, 2011

Documentation needed for Outpatient Lab and Diagnostic Tests

•    Please be sure documentation submitted is legible.
•    Please submit records for all dates of service on the claim.
•    Please ensure the medical records submitted provide proof the service(s) was ordered and rendered. Also, ensure the medical records provide justification supporting medical necessity for the service by submission of the following documentation:
o    Physician order/intent.
o    Diagnosis/ progress notes supporting medical necessity of test (may include history and physical).
o    Date of onset.
o    Documentation supporting diagnosis billed, i.e., office notes.
o    Test and/or laboratory report (may need notes from referring physician if clinical indications for ordering the test are not listed on the report). Ex: Reference lab results are often located at offsite lab.
o    Physician interpretation/notification of results.
o    Any other documentation supporting medical necessity such as nurses’ notes, physician follow-up, medication administration records (for blood glucose, physician follow-up and notification are required).
o    Pathology reports for pathology services.
o    Specimen “counts” in progress/physician/operative reports to support units billed for pathology services.
o    Signatures/credentials of professionals providing services.
o    Any other documentation a provider deems necessary to support medical necessity of services billed, as well as documentation specifically requested in the Additional Documentation Request (ADR) letter.

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