HCFA tightens up on documentation
Strict new regulations governing automated laboratory tests allow Medicare carriers to require that physicians document the medical necessity of tests ordered.
In the past, if only one or two tests in a panel were documented as being medically ecessary, the Health Care Financing Administration (HCFA) would reimburse for the entire panel. But that fostered overutilization, fraud, and abuse of laboratory tests, HCFA officials say. Now, HCFA officials expect that greater vigilance in reviewing the medical necessity of some panel tests will eliminate those abuses.
In addition, new technology now makes it possible to perform individual tests that were cumbersome in the past under automated laboratory technology.
For those concerned that the new tighter regulations will make it more difficult to order screening tests, experts recommend the following steps to document the medical necessity of screening tests:
• When you see a patient, consider what tests he or she needs in light of the symptoms displayed and order only those tests.
• Document in the patient’s record what the symptoms were and what tests were ordered.
• Provide diagnosis information on a regular, consistent basis to the laboratories you deal with.
The American Medical Association (AMA) and HCFA continue to discuss the issue of automated panels. The AMA would like to establish disease-specific panels that correspond to specific diagnoses. Another option is to eliminate CPT codes for automated panels altogether.
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