Clinical Lab Decision Support System for Quality Test Ordering and Utilization with Increase Reimbursement

Abstract Introduction/Objective It is estimated that at least 20% of the 5 billion lab orders submitted annually are inappropriate. Use an appropriate laboratory test utilization management system (TUMS) can significantly overcome this. Laboratory Decision System (LDS) only automated TUMS to assist providers understand, select, order, and optimally utilize tests for disease diagnosis management. This algorithm-based LDS rates scores potential any given assigns interpretable numeric score based on clinical relevance, medical necessity, indication. Importantly, every using will also have right CPT ICD-10 codes assigned meet necessity improve reimbursement. Therefore, in this study, we evaluated performance as a testing its ability Methods/Case Report A total 96,170 were analyzed from reference laboratory. Of these, 814 accompanied by invalid ICD10 code 44,671 or described Medicare “never covered” because inability necessity. 160,449 subject policy review which 112,400 met coverage criteria 48,049 did not. These then reevaluated LDS, be accessed app.medicaldatabase.com/site/api/cpoe interfaced with EMR determine if would improved selection Results (if Case Study enter NA) original order sample, 91.5% had associated score. these scored tests, 47.80% 43.73% failed coverage, according Ranking System. provided recommendations alternative diagnostic could aided physicians choosing more submitting different 96.4% above 5, meeting 80.5% recommended policies. Conclusion such ordering database indication, eventually help select reduce miss-utilization tests.