Federal standards for labs are constantly changing. This makes medical testing a challenge for most companies as they strive to provide quality service to patients. Understanding current codes at the state and federal levels is a lot of work for busy companies, and we realize that. 

Lab compliance is the policy, standards, and methods for which tests are done and how results are analyzed and used. Laws state that any decisions must be based on data to determine the next steps.

The Benefits of Lab Compliance Monitoring Services

The third component concerns the necessity of specific tests and their role in a patient’s well-being. Labs are held to the highest standards for medical testing and results. Billing for services should be held to the highest standards.

Medical Testing and Results

For medical testing to be effective, it must first be accurate. Results should be interpreted such that they are beneficial to doctors and patients. However, lab testing must also be fully compliant with ethical and safety regulations so that your lab can operate fully under the law. 

The most common hazards in lab settings are animal, biological, chemical, physical, and radiological.

Safe testing is knowing your material, which helps you prepare if something happens. If it’s biological, such as a bloodborne pathogen, you can be prepared to work without the risk of exposure. There may be specific regulations that require compliance for your safety and the safety of others. 

Our team knows current standards and can keep you up to date on using best practices in the field.

Determine Medical Necessity

Your first step is to ensure that the required tests are medically necessary. Most insurance carriers will only pay for an examination if the doctor orders it with good reason, so doing a little research is needed first. 

Each test must be diagnostic and must be able to achieve positive treatment outcomes for patients to be approved for insurance payments. In some cases, a requisition form may be needed to obtain medical codes for billing purposes.

Determine if Billing is Accurate

Billing mistakes are common and are often the result of something that’s overlooked. Consequently, it is your responsibility to ensure that this doesn’t have to happen. You and your team should check if the tests were done before billing. This will prevent the likelihood of a fraud investigation and could save your company a lot of money.

Medical billing is intense and involves a sound knowledge of medical codes for accuracy. It also includes a fierce three-way communication between physicians, labs, and third-party payers such as insurance companies. Doctors may order new tests, which increases the work for laboratories.

Fraud and waste are two recurring themes in medical billing practices. Both result in high costs for labs and other medical facilities and result from falsifying records. Our team can help you target these problems with effective outside monitoring services.

Check Standing Orders

Standing orders allow nurses and medical assistants to continue treatments without doctor’s orders. For labs, this means being watchful. The upside of standing orders is that testing and treatments can be done efficiently without any bureaucratic red tape. However, they must be checked for changes. Some tests may be discontinued, or the doctor might need to order a new one.

Beware of Marketing and Referral Bias

Bias in marketing and advertising is rampant. Many drug companies still offer financial incentives for physicians to order more testing and treatments. Many patients are overtested. The result is unnecessary treatments for an illness that a patient may not have had to begin.

Relationships with doctors, hospitals, and clinics must remain strictly professional to guard against bias and fraud. In short, any marketing efforts used by your lab should be honest, ethical, and straightforward.

Keep Accurate Records

Accurate records reflect good testing and treatment protocols. They demonstrate reasonable compliance efforts with you and your lab team. Documentation should be fair, accurate, and honest. Since compliance laws can change frequently and without notice, good legal counsel may be necessary. An attorney can help you review your notes and correct any mistakes during the process. Record keeping that’s accurate prevents fraud, waste, and abuse and helps keep your laboratory right on track.

Perform Compliance Reviews of Team Members

Holding people accountable is essential, and the best way to do so is to enforce compliance. You can include compliance efforts while conducting periodic employee performance reviews. Another method is to have a reliable structure that ensures disciplinary action for those who do not comply with current standards. 

One way to enforce this structure is through ongoing audits of current policies. You can examine their effectiveness and determine any need for policy changes when doing so.

Communication is key to keeping compliance measures current and working effectively. Routine staff training can support your team informed of any changes needed. 

If there’s a change in the billing policy, your team should know. They’ll need to know if any procedures have changed and what needs to be done next. Employees should be encouraged to report compliance violations to their immediate supervisor right away.

What Next?

Compliance is tricky and challenging for most companies. In medicine, it can be incredibly complex. Fraud, waste, and abuse are at the crux of the problem. But with effective outside monitoring services, you can take a load off of yourself. 

We can help monitor everything so that you can put your energy towards effective testing that’s safe, affordable, and accurate for a proper diagnosis and effective treatments that work. Call or visit our website: Innovative Lab Solutions, to learn more.