Medicare Signature Requirements and Lab Services

I need opinions. We have a multiple speciality clinic, with FPs and IMs as the majority. A lot of times Medicare patient's will come in 2 to 3 days early from their next appointment to have labs drawn. Sometimes we can find "orders" in the patient's last visit chart notes, but most of the time, we can't. The "float" nurse will draw the labs, probably by a verbal order, and then just pull the patient's problem list or past medical history to give diagnosis for these labs. I am having a hard time with this has there is no order show intent or medical need for these labs. Some cases the patient comes in a couple days later and the provider does treat the patient according to the lab results, do you think an visit after the labs would substantiate as an "order" for labs drawn previously? The Medicare policy states there needs to be proof of intent? Because I have a problem with this being compliant with Medicare policy, I have brought it up as an issue with the CEO, he states you can prove intent after the labs are drawn as long as the provider makes note of it. I'm not sure I agree, but I was also direct to "not call Medicare" about this. I'm trying to balance my coding ethics with a paycheck. Any thoughts? Oh, what about labs that don't have an order at any time for labs drawn on Medicare patients? There is a mandatory submission rule, but I don't what to file a claim on services that don't comply with the diagnostic order guidelines. Any thoughts there? Thank you.

re: Medicare Signature Requirements and Lab Services

An “order” is a communication from the treating physician/practitioner requesting that a diagnostic test be performed for a beneficiary. The order may conditionally request an additional diagnostic test for a particular beneficiary if the result of the initial diagnostic test ordered yields to a certain value determined by the treating physician/practitioner (e.g., if test X is negative, then perform test Y). An order may be delivered via the following forms of communication:
• A written document signed by the treating physician/practitioner, which is
hand-delivered, mailed, or faxed to the testing facility;
• A telephone call by the treating physician/practitioner or his/her office to the
testing facility; and
• An electronic mail by the treating physician/practitioner or his/her office to
the testing facility.
If the order is communicated via telephone, both the treating physician/practitioner or his/her office, and the testing facility must document the telephone call in their respective copies of the beneficiary’s medical records.
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R80BP.pdf
Laboratory services must meet all applicable requirements of the
Clinical Laboratory Improvement Amendments of 1988 (CLIA), as set forth at 42 CFR part 493. Section 1862(a)(1)(A) of the Act provides that Medicare payment may not be made for services that are not reasonable and necessary. Clinical laboratory services must be ordered and used promptly by the physician who is treating the beneficiary as described in 42 CFR 410.32(a) , or by a qualified nonphysician practitioner, as described in 42 CFR 410.32(a)(3).

re: Medicare Signature Requirements and Lab Services

There HAS to be an order (either written or verbal) for the lab. If the nurse of lab tech picks a diagnosis from the problem list or asks the pt, this could be considered fraud. You are correct, there has to be a reason and a diagnosis for the lab at time the lab is drawn.