tci Medicare Compliance & Reimbursement - 2005 Issue 24

LABS: Know Diagnostic From Screening For Testing Claims

If a screening is deemed medically unnecessary, Medicare will deny the claim.If labs don't know when a test stops being a screen and becomes a diagnostic tool, they could be losing valuable reimbursement. Here's help."Screening tests are used when there's no reason to believe a particular medical condition exists," explains Jim Root, an independent lab consultant in Tucson, AZ. Screening tests are meant to identify problems that need medical attention in otherwise well patients.The problem with screening tests is that Medicare won't pay for tests that have no medical necessity, says Pat Trela with PaTrela...

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