HCFA clears way for new lab rules
December 1, 1999 2 minutes read
HCFA clears way for new lab rules
Here’s what would be affected
Moving faster than expected, federal regulators have green-lighted proposed rules setting new national coverage and administrative policies for Medicare Part B-covered laboratory services. The proposals were developed during 14 months of negotiations involving providers, industry groups, and the Health Care Financing Administration (HCFA).
Once finalized, the new policies will apply to all providers, Medicare carriers, fiscal intermediaries, peer review organizations, administrative law judges, and competitive health plans.
According to an analysis of the recommendations by the Medical Group Management Asso ci ation of Englewood, CO, here’s what the new rules will affect:
• Documentation and record keeping.
The rules clarify that the ordering physician must only maintain documentation of medical necessity in the beneficiary’s medical record, and the ordering physician’s signature is not required on the requisition form. Information requests at postpayment reviews are to be streamlined. Payers or Medicare contractors that request more diagnostic documentation from the ordering physician to justify a claim must abide by existing confidentiality standards when reviewing the information.
• Claims processing.
The rules clarify that Medicare does not require claims to match diagnosis and procedure codes, and, in its absence, requires that contractors examine all submitted codes on prepayment review.
They also:
— specify that Medicare contractors with computer systems that accept fewer than eight ICD-9-CM codes permit the provider submitting the claim to put additional codes in the narrative field until implementation of standards that will require eight codes;
— enable laboratories to assign a diagnosis code to a narrative, even if the wording of the narrative does not exactly match the code descriptor for the ICD-9-CM code;
— require HCFA to instruct its contractors to refrain from denying claims solely because there is no matching of diagnosis and procedure codes on the claim form.
• Systems changes.
The rules require HCFA to provide a grace period of not more than 12 months after the effective date of the final rule to accommodate any computer system changes required by the policy changes or clarifications, to accommodate any problems caused by conflicts between laboratory and physician office systems.
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