| Providers in AR, CO, LA, MS, NM, OK, TX, Indian Health & Veteran Affairs | |
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This checklist is intended to provide healthcare providers with a reference for use when responding to medical documentation requests for laboratory testing services. Healthcare providers retain responsibility to submit complete and accurate documentation.
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Documentation description |
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Documentation is for the correct beneficiary. |
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Documentation is for the correct date of service. |
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Documentation to support a signed order for laboratory test or medical records to support the intent to order by the treating physician, (i.e. signed office visit note, signed progress note, or signed physician order/requisition). |
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Signature attestation or signature log (for illegible signatures) from physician's progress notes supporting medical necessity or intent to order. |
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Documentation to support the medical necessity of the laboratory tests ordered in accordance with all Medicare regulations and any applicable NCDs or LCDs; Jurisdiction L LCDs and Jurisdiction H LCDs. |
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Documentation to include laboratory test results. |
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If applicable and required, submitted documentation should include a beneficiary waiver of liability. | This checklist was created as an aid to assist providers. This aid is not intended as a replacement for the documentation requirements published in national or local coverage determinations, or CMS documentation guidelines. It is the responsibility of the provider of services to ensure the correct, complete, and thorough submission of documentation.
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