Drug testing is part of a complete patient evaluation and ongoing risk monitoring in most medical practice settings when treatment involves long-term use of controlled medication. Today’s licensing board guidelines and rules, and position papers published by professional societies, make clear that drug testing should be performed and test results should be used in a timely fashion to guide medical decision-making prior to initiating controlled substance therapy, especially in the nonterminal, subacute, and chronic settings, and in ongoing patient risk monitoring and corresponding treatment plan adjustments. If a provider has his/her own clinical laboratory, or certain types of business arrangements with an independent clinical laboratory, failure to appreciate a new federal law impacting clinical laboratory or payor policies setting forth documentation requirements for medically necessary testing may spell financial disaster for the provider. Providers should review their current drug testing practices and, where applicable, coverage and reimbursement policies, to improve their ability to demonstrate quality patient care and adherence to the ever-developing body of laws and regulations governing controlled substance prescribing. Providers in business relationships with independent clinical laboratories or laboratory set-up companies should be generally familiar with a new federal law that may render suspect or unlawful certain aspects of these business arrangements, which may potentially expose the provider to allegations of fraud and abuse or recoupment for overpayments. Providers who proactively address any deficiencies or weaknesses in their use of drug testing in the context of controlled substance prescribing will largely minimize the potential for bad patient outcomes and related legal liability associated with controlled substance prescribing and the financial aspects of clinical laboratory. Using a series of “do this, not that” cases, attendees will learn how to distinguish poor workflow and documentation in drug testing from efficient and effective assimilation of standards of care and payor policies on medical necessity into their personal styles of patient evaluation and ongoing care. Attendees will be given two basic tools to reinforce learning objectives: a workflow template and an adaptable form to help the provider make timely and reasonably prudent ongoing treatment decisions, all of which may help the provider minimize the potential for an overdose event.
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