Drug Testing and Reimbursement for Patients with Chronic Pain

Jennifer Bolen

Founder
The Legal Side of Pain®
Knoxville, Tennessee

The regulatory and reimbursement environment surrounding drug testing is becoming increasingly stringent. Importantly, every practice should have general compliance guidelines to keep pace with changing regulations from government and commercial payers. Because drug testing often involves reimbursement claims, clinicians need to provide a clear and documented rationale for a specific drug test and its frequency. Overutilization of drug testing may cause reimbursement issues with payers and for patients. The Centers for Medicare and Medicaid Services recently clarified its billing code rules, which affect the use of drug screens, their associated reimbursement values, and confirmation testing. Commercial payers themselves are also crafting policies and position statements to guide clinicians about how to code for drug tests. Clinicians can work with coding and/or compliance specialists to conduct an internal audit of their reimbursement practices and address any over-reimbursement with those specialists and legal counsel to reduce the risk of fraud investigation by the Office of Inspector General. Here, Jennifer Bolen discusses proper reimbursement coding for drug testing and what healthcare providers can do to set up a general compliance program in their practices.

References

1.    Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-130.
2.    Butler SF, Fernandez K, Benoit C, Budman SH, Jamison RN. Validation of the revised Screener and Opioid Assessment for Patients with Pain (SOAPP-R). J Pain. 2008;9(4):360-372.
3.    Weiss RL. Coding, coverage, and compensation for pathology and laboratory medicine services. Clin Lab Med. 2007;27(4):875-891.

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