Practice Management Alert

Question: Ive heard that Medicare will never pay for lab codes. Is that true?
       
Alabama Subscriber

 


Answer: While there are some laboratory codes that Medicare wont pay, in many cases you can be reimbursed for these services, says Jennifer Darling, insurance and collection specialist with the Center for Oncology Research & Treatment in Dallas.
 
As long as you include the CLIA (Clinical Laboratory Improvement Amendments) number on your claim, mark yes on box 20, note the purchase price and follow all other normal clean claim requirements, Medicare will reimburse you for medically necessary services provided within the allowed timeframes, Darling says. Of course, you have to have the proper CLIA level to perform certain lab tests in your office, she reminds providers.
 
Keep in mind that the lab will bill you, and then youll turn around and bill the insurance carrier. To ensure that both you and the lab dont bill the insurance, mark physician bill on your lab requisitions, Darling instructs. And since the insurance will pay you more than the lab charges, you make a profit, she says. Of course, youll have to spend some time making sure you bill the insurance carrier for everything the lab has billed you for, but if youre diligent and up to the task, you can manage it fine, Darling assures.

 
These reader questions were reviewed by Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc. in Spring Lake, NJ.