Physician Order for Diagnostic Laboratory Tests
September 29, 2011Recent Comprehensive Error Rate Testing (CERT) analysis reveals an increase in errors for diagnostic laboratory services. The CERT errors are attributed to the absence of documentation supporting the physician orders or the physician intent to have the diagnostic laboratory tests performed. Submission of appropriate documentation in a timely manner will decrease the number of errors and claims denied by the CERT contractor. An “order” is a communication from the treating physician/practitioner requesting that a diagnostic test be performed for a beneficiary. The medical record and/or the request itself must clearly document the physician’s intent for the diagnostic test to be performed. Tests not ordered by the physician who is treating the beneficiary are not reimbursable. Although no signature is required on an order form for a clinical diagnostic test paid on the Laboratory Fee Schedule, the physician must clearly document, in the medical record, his or her intent to have the test be performed. The entity providing the laboratory test results must maintain all documentation, including the physician order and the test findings, to support the claim submitted. Laboratory medical records are requested to determine correct billing and medical necessity. Noridian Administrative Services: Carrier/FI for Arizona, Alaska, Idaho, Oregon, Montana, North Dakota, South Dakota, Utah, Washington, Wyoming and Minnesota.