I may get myself into trouble for asking, but I need some assistance with a practice that I have been questioning for over two years. I'm hoping that someone can help me out and put this to bed once and for all.
I work for a clinical toxicology lab that does urine drug screening.They offer this service called a "Second Look", which means that if they (the counselor) don't find what they were looking for in the first drug screen panel that was run, they can order a "Second Look" and order another screen that does not include the drugs screened for in the first look. Let me mention that these are both SCREENS (G0431 or 80301), not definitive tests. At some of our clients this is a routine practice, which tells me that they are not ordering the correct tests initially....
Let me add that they only allow them to screen for 6 drugs at a time "because of reimbursement".
THIS ALL HAPPENED PRIOR TO ME and I have been trying to correct things at this place for over a year. I'm making progress, but this one still nags...
Let's add to that the fact that this particular lab was using processing date rather than collection date as the service date, so these "Second Looks" looked like two different claims.
After a very heated debate they finally listened to me and used the collection date as the service date for the drug screens, but that had a negative impact on the Second Looks because they had the same date of service, so they are denied. (duh, of course). In a desperate attempt to hang on to that revenue stream, modifier -91 was used on the G0431 for the 2nd Look. Of course it is denying as well.
Someone then read the Medicaid Regulations related to Collection Date :
24. The Medicaid definition for "date of service" for laboratory providers is the date of specimen collection. For laboratory tests that use a specimen taken from storage, the date of service is the date the specimen was removed from storage.
And is interpreting this to mean that on stored samples it is ok to use the Service date for stored specimens.
I've looked at that entire section related to Collection Dates and it refers to hospital services and specimens stored more than 14 days. So I am interpreting it to NOT pertain to us,
Sorry for this very long post, but this is a matter that I am VERY concerned about in terms of ethicality (is that a word?) and legality. It is causing much debate in the office because I am "bucking the system", and jeopardizing a revenue stream One that I must mention "went away" when we started using the CORRECT date for billing.
Someone please help me. I am seriously considering running out the door. I don't care about being right, I want to be compliant and legal....
I work for a clinical toxicology lab that does urine drug screening.They offer this service called a "Second Look", which means that if they (the counselor) don't find what they were looking for in the first drug screen panel that was run, they can order a "Second Look" and order another screen that does not include the drugs screened for in the first look. Let me mention that these are both SCREENS (G0431 or 80301), not definitive tests. At some of our clients this is a routine practice, which tells me that they are not ordering the correct tests initially....
Let me add that they only allow them to screen for 6 drugs at a time "because of reimbursement".
THIS ALL HAPPENED PRIOR TO ME and I have been trying to correct things at this place for over a year. I'm making progress, but this one still nags...
Let's add to that the fact that this particular lab was using processing date rather than collection date as the service date, so these "Second Looks" looked like two different claims.
After a very heated debate they finally listened to me and used the collection date as the service date for the drug screens, but that had a negative impact on the Second Looks because they had the same date of service, so they are denied. (duh, of course). In a desperate attempt to hang on to that revenue stream, modifier -91 was used on the G0431 for the 2nd Look. Of course it is denying as well.
Someone then read the Medicaid Regulations related to Collection Date :
24. The Medicaid definition for "date of service" for laboratory providers is the date of specimen collection. For laboratory tests that use a specimen taken from storage, the date of service is the date the specimen was removed from storage.
And is interpreting this to mean that on stored samples it is ok to use the Service date for stored specimens.
I've looked at that entire section related to Collection Dates and it refers to hospital services and specimens stored more than 14 days. So I am interpreting it to NOT pertain to us,
Sorry for this very long post, but this is a matter that I am VERY concerned about in terms of ethicality (is that a word?) and legality. It is causing much debate in the office because I am "bucking the system", and jeopardizing a revenue stream One that I must mention "went away" when we started using the CORRECT date for billing.
Someone please help me. I am seriously considering running out the door. I don't care about being right, I want to be compliant and legal....
Legal\Ethical Question re: Urine Toxicology Testing
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