The Trouble with Urinalysis Testing
Changes in Near Future, Emerging Best Practices for Chemical Dependency Treatment Providers
In an informal meeting last month our CEO spoke with representatives of payers and a highly reputable testing lab about the role of urinalysis testing in chemical dependency treatment.
In plain language, the perception among insurance industry payers of the value of UA testing has been a problem, particularly recently. With urinalysis testing unsupported by sufficient clinical data, payers are finding billing rates excessive, and questioning the frequency with which patients are being tested. When a question arises, current policy among payers is either to deny coverage, or to request the patient’s full medical record. We estimate that approximately 62% of UA billings do result in a request for medical records. For your facility or practice, each request represents an obvious drain on your administrative resources. Still more problematic are UA claims that continue to return persistent denials in spite of providers’ compliance in supplying medical records. As of this writing, our Special Claims Department estimates the number of persistently denied UA claims to be above 40%.
We believe that urinalysis testing is not being presented as a clearly integral part of most patient treatment plans, with the result that payers’ perception of its value in chemical dependency treatment is not reflective of its value to you, the treatment provider. We believe that in the near future payers are going to be changing their requirements and policies for UA testing and billing in ways that reflect their present assessment of its value.
Omneity Billinginvites you to work with us to bring in all that is lawfully yours.
We are strongly advocating for an active approach to UA documentation practice. Providers in chemical dependency already know the value and necessity of UA testing. Omneity Billing clients are going to be out ahead of changes in UA billing because of protocols we are developing that will show the value of urinalysis testing to payers in a quantifiable manner. Our responsive practice guidelines are directed toward achieving a three-fold strategy:
- Avoid the cycle of UA claim denial
- Establish legitimacy of UA testing as integral to the treatment process
- Enhance the long-term credibility of your facility or practice
The truth is that payers want to build relationships with reputable treatment facilities and practices. Because of our relationships with top payers, Omneity Billing is ahead of the curve on UA billing protocols, and can bring your facility’s UA testing routines into line with new practices before they’re implemented. We’re bringing these three goals within reach by advancing a system for providing documentation and data to payers that supports medical necessity for UA testing.
Omneity Billing Aims for Future UA Protocols
We believe our first, best tactical action is to link UA testing with the patient’s treatment plan, and consistently track results to build quantifiable evidence of medical necessity:
- Protocols activated before testing begins
- Consistent action throughout treatment plan
- Leveraging clinical involvement in support of testing
A dynamic response to present perceptions will build payers’ understanding of the value of continuous testing. Additionally, as chemical dependency treatment providers, you know that a negative test result may not be all it seems. At Omneity Billing, we also believe that consistency of documentation, established in clear relation to the patient’s overall record, will be the key to eventually establishing the value of payment for negative as well as positive test results.
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About How Patients Can Return False Negatives
In the future, we are hoping to see forward-thinking facilities take advantage of in-office strip test methods that will indicate when test cheats may have been used, before incurring the expense of a full laboratory test. Such test strips are already available from the better laboratories. Besides the obvious savings of time and money to both facility and payer, such a test would ultimately benefit patients’ quality of treatment by allowing for immediate, on-the-spot clinical response.
Treatment Providers, Laboratory Service Providers, and Payers: Building Alliance
Arbitrary limits on reimbursements and restrictions on the number of tests; number of analytes; panel composition and type; frequency of testing; or methodology of testing interfere with the physician’s judgment and represent a discriminatory action prohibited by federal mental health and addiction parity legislation, which states that any limitations on addiction care may not be substantially different from limitations in any other area of health care.
Drug Testing As A Component Of Addiction Treatment and Monitoring Programs and in Other Clinical Settings. (n.d.). Retrieved from
While we at Omneity Billing are passionate about safeguarding insurance patient access to treatment options to the fullest extent of the law, the solutions we design must consider all participants in patient care: insurance payers, as well as providers. Bring your facility’s UA billing needs to us, and be sure that we will be working not only to speed and maximize your revenue cycle, but to enhance your relationship with insurance payers as well.
About Omneity Billing
Omneity Billing is the comprehensive provider of insurance billing services to the behavioral healthcare community. We are here to enforce the legal obligation of insurance companies to provide medically necessary care, and protect the rights of patients and those who treat them. From our detailed eligibility summaries and powerful utilization support, to the individualized care of our unprecedented Family AdvocacyÂ© Department, we are dedicated to supporting the viability of treatment facilities nationwide.