Wiki FQHC Billing and Clia waived testing.

[dbjjgibs]

Can anyone tell me if they are billing CLIA waived tests at their health centers?
I know they are included in the "encounter rate" for Medicare and will go on the cost report to recoup our costs.
However for all other insurances are you/can you bill the limited CLIA waived tests using the QW and be reimbursed?
What billing procedures are you following in your practices?
If so, how are you determining the costs when the supply cost is so minimal?

Thanks!

 

[Chelle-Lynn]

With the Medicare guidelines that went into effect a few years ago we no longer list the lab codes on the Ub04 claim forms for additional documentation such as:

G0467
99213
81003QW (not listed)

Since Medicare does not allow for the lab to be listed on the claim, we report this in our year end summary for cost report.

 

[j_oania@yahoo.com]

Hi,
The billing staff at the FQHC I work at believe that services like CLIA-waived tests should also be on the same claim as the E/M visit. But I have reason to believe this isn't correct. Aren't lab services (excluding 36415) considered non-FQHC services, and should be billed as such?

According to the Medicare FQHC Manual:
"60 - Non RHC/FQHC Services
(Rev.239, Issued: 01-09-18, Effective: 1-22-18, Implementation: 1-22-18)
RHCs and FQHCs must be primarily engaged in furnishing primary care services, but
may also furnish certain services that are beyond the scope of the RHC or FQHC benefit,
such as laboratory services or the technical component of an RHC or FQHC service. If
these services are authorized to be furnished by the RHC or FQHC and are covered under
a separate Medicare benefit category, the services must be billed separately (not by the
RHC or FQHC) to the appropriate A/B MAC under the payment rules that apply to the
service. RHCs and FQHCs must identify and remove from allowable costs on the
Medicare cost report all costs associated with the provision of non-RHC/FQHC services
such as space, equipment, supplies, facility overhead, and personnel."


Noridian also states:

Non – FQHC Services:
• If covered under another separate Medicare
benefit category, services must be separately
billed to A/B/DME MAC by the appropriate
Medicare provider/supplier furnishing the
service(s)
• All costs associated with non-FQHC service
must be removed from cost report

So would that mean these services would not be on the cost report? And we should expect to get separate reimbursement for these services?