To comply, physicians should only order tests that are medically necessary in diagnosing or treating their patients, be certain to enter the appropriate and correct ICD-9 code in your patients files and on the test request forms. Always have the patients sign and date an Advance Beneficiary Notice if they believe that the service is likely to be denied, unless the physician is willing to pay for the service.
If a physician does not submit an ICD-9 for a limited coverage test, Clinical Laboratory Partners will contact the physician's office to ask for a copy of a properly executed ABN or a diagnosis indicating medical necessity.
A properly executed ABN or the ICD-9 code only permits the laboratory to bill and receive payment. In a post payment audit, the requesting physician may still be asked to show that the tests were medically necessary for a particular patient's condition. Please ask your Clinical Laboratory Partners service representative for the latest list of LMRP's and NCD's. This will assist you to identify where such situations may exist. |
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