Medicare and Private insurance companies are now becoming stricter in their coding regulations. If the diagnosis does not meet the requirement of the patient's necessity, the Private insurance or Medicare will not cover laboratory expenses. If the Medicare patients have signed an ABN, the patient will then be responsible for payment of the laboratory tests not covered. Please note: if the patient has Medicare, and the test being ordered is part of the commonly ordered 23 tests, please review the diagnosis codes with MuirLab's NCD Manual.
At times, physicians request that MuirLab re-bill a claim with new diagnosis codes. As the client, you will need to make sure the requests are made (on letterhead) specifying the new code and the reason it is being changed/added. Please make sure the letter is signed by the physician and not a member of the staff. According to United Government Services; "Submitting only an acceptable diagnosis is not enough". In order to resubmit a claim, MuirLab needs to make an appeal with the physician's records to support that the test was medically necessary. In an attempt to prevent unnecessary work, and avoid the patients being billed, please make sure you are checking the requisitions for valid diagnosis codes before the patient leaves your office. If you would like further information regarding Medicare Regulations, please visit www.ugsmedicare.com.
Often times Diagnosis Codes are missed because staff is not completely educated on what a diagnosis is. Please remember that the meaning of a diagnosis code is associated with the signs and symptoms of the patient. Currently, MuirLab's Business Account Representative, in conjunction with the Diagnosis Code Department, are working together to educate MuirLab's clients on how to fully and accurately fill out requisitions.
In any given month, if a physician or physician's staff fails to send these codes, at month's end, the Diagnosis Department will send out a diagnosis list. Once this list is completed it must be signed and faxed back to MuirLab's Diagnosis Department. If a patient's information is not entered on this monthly report then that patient will automatically roll over into the next month's list. If patients are ignored for several months the result is that MuirLab is out of Compliance as it relates to the diagnosis codes. Please remember, if for any reason MuirLab is audited, you, as the client, will also be audited.
It is important to take whatever time is necessary to make sure the diagnosis codes are in the proper place. Doing so will ensure that your patients are free of needless phone calls and unnecessary bills. Your cooperation is extremely important. MuirLab appreciates those of you who diligently complete your respective lists!