BNP Denials

Jacoder

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As many of us already know, Medicare is doing "pre-payment review" of all BNPs. (It may be jsut GA, I'm not certain on that.)So far I haven't had any review of BNP's drawn in the ER or IP, but every one that is drawn outpatient is being rewested for review. This is leading to problems because some of our doctors are ordering them to be drawn in 4 days (for example, nursing home patients) or they are ordered to be drawn once a month (home health patient). These are being denied because according to Medicare they do not have the documentation to support that it is necissary. It is considered a "point of service" lab which means "performed and immediately used in the disposition of patient care".

Has anyone had this same problem and how are you addressing it? One nurse practitioner pointed out that when she orders a BNP monthly for her home health patient, it very frequently comes back at a critically high level and they immediately treat the patient either by giving them lasix or sending them to early dialysis. Is this considered "point of service"?
 
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