#28: Documenting the Medical Necessity of Lab Testing

 Many toxicology laboratories work with addiction clinics that are cash pay and ILDP is not an exception.  Although this is a great business model, one of the issues all labs run into is billing the insurance of patients who attend cash pay clinics.  All patients being drug tested should be asked if they have any type of health insurance or if their health insurance has changed on each visit.  I realize this sounds like overkill, however as your partner in drug testing, we cannot be reimbursed for our services without the correct insurance information.  It is the practice of many clinics, and was in the clinics I previously owned, to request the insurance card from the patient on every visit to compare it to what the clinic has on file.  Often patients will obtain or change health insurance from one visit to the next.  If they present an insurance card, a copy of the front and back should be made and sent to the lab.  This will ensure the services the provider requested the lab to perform are able to be billed correctly.  In addition, many times insurances being what they are will request medical records/office notes for the particular visit when the patient sample was collected. 

Here is where it gets sticky.  Medical documentation is one way insurances love to deny claims.  Even if your clinic is a cash clinic, laboratories bill insurance, and therefore must comply with insurance requests in order to be reimbursed.  With the amount of fraud that goes on today, insurance companies want proof what they are about to pay for was done and, in their minds, was medically necessary.  Therefore beyond the lab reports, which we supply them with daily, they want to see the documentation of medical necessity for the drug test, from the provider.  According to CMS, the majority of improper payments to laboratories were due to insufficient documentation.  For example, the medical record was missing the documentation to support the intent to order a drug test.  The progress note was not signed by the provider, (they love this one) or no documentation of a signed provider order.  Also, documentation of medical necessity to test the patient was not sufficient.  “Run Labs” or “order drug tests” is not a sufficient note in their world. 

All providers have been schooled as to how to document.  Insurances move the goal posts all the time so we miss the field goal long enough for them to make some more dough!!  Did I tell you I greatly dislike insurance companies?  The bottom line, as a lab we play on their field and therefore by their rules.  Any way you are able to help us, we greatly appreciate.  Please document why you are testing the patient and what you are testing for.  As simple as, “Patient is prescribed an opioid so I am ordering a drug test for opioids, illicit and additional drugs that may produce a decrease in respiration if combined with opioids, to ensure compliance and decrease the potential risk of drug interaction.”  Please, please, please get us documentation when we request and rest assured it is not coming from us!   Thank you all for trusting us and sending us your business!!

Lance Benedict

President/CEO Industry Lab Diagnostic Partners  

01/15/2020

#27: The Provider-Patient Relationship is Paramount!

Recently I had a provider call me and reveal that one of his patients felt betrayed by him because his patient complained they were being treated like a drug addict after the patient “discovered” he had been drug tested.  The provider explained since he ran a pain clinic he assumed all patients knew they would be drug tested.  Theoretically, patients being seen at a pain or SUD clinic should realize they will be drug tested, however, every clinic should have a protocol in which the purpose, as well as the procedure of the drug test, should be explained prior to the drug test.  The provider-patient relationship is paramount for obtaining the best outcome from treatment.  When a patient is confronted with results of a drug test they assumed, justly or unjustly, was for different purposes (cholesterol or glucose levels) the conversation with them regarding those results changes drastically, potentially damaging that crucial relationship.  The reason for the drug test, what is done with the results, and explaining the confidentiality of the results should always be done prior to the patient supplying a sample. 

Everyone involved in the drug testing should communicate openly (within their scope) with the patient, using an understanding attitude.  All should be “singing the same song.”  All drug testing staff should have a clear understanding of and be able to recite the clinic's protocols, regardless of who the patient seeks an explanation from.  All patients should be treated with dignity and respect, with a straight forward, nonjudgmental attitude.  Explaining the reasons for drug testing and any subsequent treatment in a matter-of-fact, non-confrontational manner significantly decreases confrontations.  Only the providers who ordered the drug tests and have control over the patient’s treatment should discuss results.  Patients will many times seek the “weakest” link to obtain a sympathetic ear, using anything that may be discussed with them to their advantage.  Deferring any questions to the provider is the safest course of action for clinic staff to take and is the only response a collector should have. 

Whereas drug testing will seem intrusive to some patients, others may welcome the discipline imposed upon them.  While making drug testing black and white may seem harsh to some, all must remember it is not done to be punitive.  In dealing with patients who contact the lab regarding results they didn’t like (they never seem to call about normal results), we take the same approach.  Those of you in my age bracket may remember the famous words of Joe Friday, “Just the facts, Ma’am!”  We give them only the facts we know from their test.  We do not speculate as to why they might have been positive or negative, regardless of the stories they attempt to tell us.  We may discuss possibilities with the providers should they call, but never with the patients as they tend to twist discussions in their favor.

I hope all of you had a Happy New Year.  We look forward to working with you this year and I thank you all for your business.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners

01/10/2020