Tuesday, April 23, 2019

Quality to the Next Level


Use Compatibility Mode
in Internet Explorer 9 or higher

Diagnostic Testing Services

Minimize
1-832943892 - Friday, May 10, 2013

Rationale for the Referral:  The ALJ erred in finding a physician’s order and test results are sufficient to satisfy an IDTF’s documentation requirements for purposes of Medicare payment and sufficient to establish the diagnostic tests were reasonable and necessary in accordance with 42 C.F.R. §§ 410.32(a) and 410.33(d).

Referral Document

Appeals Council Decision

 
1-840363739 - Friday, May 10, 2013

Rationale for the Referral: The ALJ erred in failing to consider the requirements of 42 C.F.R. § 410.32(a) and relevant local coverage determinations. Additionally, the preponderance of evidence in the record does not support the ALJ’s determination that the services were reasonable and necessary.

Referral Document

Appeals Council Decision

 
1-936511399 - Friday, May 10, 2013

Rationale for the Referral: The ALJ erred in finding a physician’s order and test results are sufficient to satisfy an IDTF’s documentation requirements for purposes of Medicare payment and sufficient to establish the diagnostic tests were reasonable and necessary in accordance with 42 C.F.R. §§ 410.32(a) and 410.33(d). The ALJ also erred in failing to consider relevant local coverage determination criteria.

Referral Document

Appeals Council Decision

 
1-936511399 - Monday, May 6, 2013
Rationale for the Referral: The ALJ erred in finding the physician’s orders, Statements of Medical Necessity and test results sufficient to establish the diagnostic tests were reasonable and necessary and to satisfy an IDTF’s documentation requirements for purposes of Medicare payment.

Referral Document

Appeals Council Decision

 
1-921456878 - Monday, April 1, 2013
Rationale for the Referral: DNA Specimen Provenance Assay (DSPA) tests are not diagnostic laboratory tests, do not otherwise fall within a Medicare benefit category, and are not covered by Medicare.

Referral Document

Appeals Council Decision

 
1-902902573 - Friday, February 22, 2013
Rationale for the Referral: A physician’s orders and test interpretations alone are not sufficient to establish the diagnostic tests were reasonable and necessary in accordance with 42 CFR sections 410.32(a) and 410.33(d).

Referral Document

Appeals Council Decision
 
  
Copyright 2010 by Q2 Administrators. LLC. All Rights reserved