How to handle claims with missing lab scans?

[j.b3nny.bc]

I'm a new coder and also new to this forum. I'm hoping to get insights here before bringing this up to my colleagues and superior.

Our clinic has this rule that for certain services like flu, COVID, strep, RSV tests, the actual lab test results need to be scanned into the patient's chart before we can release the claim to insurance. However, sometimes this doesn't happen. The provider will have clearly documented the lab results in their clinical notes, but the scanned document is missing.

Can I release the claim to insurance in this situation? What's the risk of not having the scanned test result in the chart, even if the provider's note is crystal clear? Or do I just insist on a physical documentation? Any advice how to do that? I'm worried about potential audits and denials. Thanks for your insights!

 

[Skylah.Gen]

Stick to the scanned docs if that's the clinic policy, it's what auditors usually expect as proof. Provider notes help, but insurance audits tend to look for the actual lab report so releasing claims without the scanned test could lead to denials or flags later.

 

[Billie.F]

You generally need the actual lab report scanned, not just the note. Insurers and auditors want to see the source document, relying only on provider notes can trigger denials or audit issues. i agree with @Skylah.Gen

 

[DoubleTrouble]

I mean in a worst case scenario a written statement from the provider might work, but I'm guessing nothing beats the actual results.