Healthcare Fraud Shield’s Latest Article: What’s in the Cup (Urine Drug Screening)?

6 Feb

With the focus on the Opioid crisis in this country and the increasing number of overdoses and deaths, prescription drugs have come under closer scrutiny. It is not just a billing issue, but also a patient care and safety issue. With those thoughts in mind, let’s take a look at Pain Management and the use of Urine Drug Screening (UDS).

A pain management physician may employ various means to address the patient’s complaint(s). The Centers for Disease Control (CDC) published Clinical Guidelines for prescribing opioids for chronic pain.[i] When narcotics are employed in the treatment of pain, UDS is an important component of the treatment regimen. Not only can a UDS provide the physician with an accurate picture of the member’s compliance with the prescribed medications, but it can also aid in the detection of drug diversion, drug supplementing, and the use of illicit drugs[ii].

According to the American Academy of Pain Medicine, UDS must be ordered by the treating physician or Nonphysician provider (NPP). In your assessment of billing data and the medical record, you should see both scheduled and random testing. The SAMHSA UDS Collection Guidelines also stipulate that standards must be established to ensure that the specimen tested is the patient’s current sample and not altered.[iii]

Scheduled Point of Contact UDS testing (e.g., every 3 months at the office appointment) is typically NOT sufficient to provide the physician with an accurate assessment of the patient’s prescription compliance, as it allows the non-compliant patient sufficient time to defeat the accuracy of UDS tests.[iv] Most payers (commercial, state, and federal) have established policies concerning UDS coverage. Please refer to your respective policies and regulations. However, the following are typical expected and unexpected findings when looking at pain management and UDS:

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[i] CDC Guidelines for Prescribing Opioids
[ii] American Association of Clinical Chemistry: Monitoring Drug Therapy in Pain Management Patients
[iii] SAMHSA Urine Specimen Collection Handbook
[iv] Pain Physician Journal: Urine Drug Testing: Current Recommendations and Best Practices

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