Question:

What are Medicare contractors looking for when they review orders for diagnostic laboratory tests?

Answer:

Federal law requires that all diagnostic tests must be ordered by the physician who is treating the beneficiary and that tests not ordered by this specific physician are considered not to be reasonable and necessary. The Medicare Benefit Policy Manual, Chapter 15, Section 80.6.1 states that while a physician order is not required to be signed, the physician must clearly document, in the medical record, his or her intent that the test be performed. 

For more on this policy, go to https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf.

This question was answered in an edition of our Laboratory Compliance Manager. For more hot topics relating to laboratory services, please visit our store or call us at 1.800.252.1578, ext. 2.

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