The remittance advice, auditing for compliance

Resubmitting claims can be costly in terms of both time and lost revenue. The remittance advice and return to provider reports received by laboratories from carriers/intermediaries are an excellent source for investigating compliance matters. The Department of Health and Human Services, Office of Inspector General, has estimated that laboratories account for 4.38% of the total improper payments paid by the Medicare program for fiscal year 1998 (1). This article will illustrate how the information in these reports can be used to assist your laboratory in capturing the reimbursement it is entitled to.