In the 2018 OPPS final rule, CMS finalized a change to the current clinical laboratory date of service policies for outpatient molecular pathology tests and advanced diagnostic laboratory tests.
Q: Does a hospital need to obtain the patient's written consent before obtaining physician office notes? Can I contact the physician office and request the needed information without obtaining a written consent from the patient? The office notes are needed for payment purposes.
In the current healthcare climate, the issue of medical necessity documentation, or lack thereof, is one of the most common reasons for claim denials. For a service to be considered medically necessary (by a third-party payer), it must be considered a reasonable and necessary service to diagnose and/or treat a patient’s current and/or chronic medical condition.
An audit of Medicare Part B payments from 2014 through 2016 revealed that CMS improperly paid providers more than $66.3 million for specimen validity tests billed in combination with urine drug tests, according to a report by the OIG.
This week’s Medicare updates include two compliance reviews from the Office of Inspector General, an enforcement instruction on supervision requirements for outpatient therapy, clarification of instructions for medical reviews of inpatient rehabilitation facility claims, and more!
