Author Topic: Lab Billing  (Read 2306 times)

Michael Kaspro

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Lab Billing
« on: April 11, 2013, 03:52:09 PM »
Hi,

I am working on setting up the lab billing. Can you please help me in finding guidelines for who can be the billable provider. When we have billed for labs performed in our office we always use the doctor that ordered the test and saw the patient. For our new lab do we need to use the referring physician even though they aren't on site or do we use our medical director?

We need to find out so we can get the billing provider(s) credentialed with commercial insurance carriers.

Thanks

RichardP

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Re: Lab Billing
« Reply #1 on: April 12, 2013, 01:55:05 AM »
We need some answers first.  We can answer some general questions here.  But if you will be billing Medicare for any of the lab work, your people seriously need to hire a health-care attorney who knows the rules for lab billing for your state.

1.  You said When we have billed for labs performed in our office ...  Where are the labs being performed now, the ones you are trying to set the billing up for?  That is, what are you setting the billing up for - an independent laboratory, or a laboratory for a group of doctors, or a laboratory for a solo practitioner who does lab work for other doctors? 

2.  Are any of the referring physicians participating providers with Medicare?

3.  Are any of the labs being billed to Medicare?  If no, do you anticipate any future lab work being billed to Medicare?

4.  Is this lab in California?

5.  What level of complexity is your lab certified for?

6.  Are you familiar with the information at the following link?

7.  You asked do we need to use the referring physician ...  We can't answer that until you have answered the questions listed above.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/CLIABrochure.pdf

CLIA standards are national and are not Medicare-exclusive. CLIA applies to all providers rendering clinical laboratory services, whether or not Medicare claims are filed.

CLIA regulations are based on the complexity of the test method. Test methods are categorized into three levels of complexity:

Waived Complexity;

Moderate Complexity, including Provider-Performed
Microscopy Procedures (PPMP); and

High Complexity.

The more complicated the test, the more stringent the requirements. CLIA specifies quality standards for PT, facility administration, general laboratory systems, preanalytic, analytic, and postanalytic systems, personnel qualifications and responsi-bilities, quality control, quality assessment, and specific cytology provisions for laboratories performing moderate and/or high complexity tests.


Medical Billing Forum

Re: Lab Billing
« Reply #1 on: April 12, 2013, 01:55:05 AM »