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QUESTION: CLAIMS: I received a denial stating the documentation submitted did not support the medical necessity of laboratory services. Can you tell me what I can submit to support these services?

Answer

Laboratory, diagnostic, and therapeutic procedures - MD order and progress notes showing medical necessity are needed.

  • Requisition forms or MD order form needed with MD signature.
  • Illegible MD signatures
    • Signature key or attestation statement is needed if MD signature illegible - by MD or Compliance Officer with typed name and MD signature
    • Alert treating physicians and medical records staff
  • Progress note by ordering physician is needed also to show the medical necessity of the services ordered. MD signature also needed with progress note.
    • Signature key or attestation statement is needed if MD signature illegible - by MD or Compliance Officer with typed name and MD signature
  • Providers with electronic ordering or progress notes systems
    • Print of screen showing electronic order or progress note (Include notation such as “Electronically signed by”.)
    • One copy per provider of the protocol that describes that the system is entered by the MD with a unique ID and password or audit trail showing MD entered system with unique ID and password
      • Alert medical records staff
  • For verification of illegible signature - Signature attestation example: “I, _[print full name of the physician/practitioner]_, hereby attest that the medical record entry for _[date of service]_ accurately reflects signatures/notations that I made in my capacity as __[insert provider credentials, e.g., M.D.]_ when I treated/diagnosed the above listed Medicare beneficiary. I do hereby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.” M.D. Signature.

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Reviewed Date: 10/15/19
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