Pathology Billing Compliance Checklist
Complete this checklist to assess and document compliance with pathology billing standards and procedures.
Practice Name
*
Date of Compliance Review
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Compliance Officer or Reviewer Name
*
First Name
Last Name
Department / Location
Are staff members trained on current pathology billing regulations and updates?
*
Yes
No
Partially
Checklist: Review each compliance area and indicate status
*
Rows
Compliant
Non-Compliant
Not Applicable
Patient demographic and insurance information is accurately collected
1
2
3
Medical necessity is documented for billed tests
4
5
6
Correct CPT/HCPCS codes are used
7
8
9
Claims are submitted within payer timeframes
10
11
12
Documentation supports billed services
13
14
15
Billing audits are performed regularly
16
17
18
Denied claims are reviewed and corrected
19
20
21
How would you rate the overall accuracy of coding and documentation?
*
1
2
3
4
5
Are there procedures in place for handling claim denials and appeals?
*
Yes, well established
Somewhat established
No procedures in place
Please list any identified compliance issues or areas for improvement
Additional Comments or Notes
Submit Checklist
Should be Empty: