Billing and medical necessity from Medicare Compliance for Clinical Laboratories, presented by MediaLab

General: Risk Areas

Billing and medical necessity

Billing:
- Highest risk activity a laboratory has. All laboratory activities contribute to the billing process.
- Many of the risk areas included in this program are components of the billing function.
Medical necessity:
- Medicare is only allowed, by law, to pay for tests that are reasonable and necessary for the diagnosis and treatment of disease.
- Medical necessity is an underlying principle of the Medicare program.
- Tests performed for screening or routine exams are not considered medically necessary by the Medicare program.

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