Wiki FQHC Billing Lab Services to Medicare Advantage plans

[j_oania@yahoo.com]

Hi,
I work for an FQHC in Hawaii and we are having issues with billing PPD tests and other lab services to Medicare Advantage plans like UHC, WellCare, etc.
Is there anyone else billing/coding for FQHCs who can share how they are billing labs to Medicare plans?

According to the Medicare FQHC Policy Manual under the subcategory Description of Non RHC/FQHC Services regarding lab services:

Laboratory services - Although RHCs and FQHCs are required to furnish certain laboratory services (for RHCs see section 1861(aa)(2)(G) of the Act, and for FQHCs see section 330(b)(1)(A)(i)(II) of the PHS Act), laboratory services are not within the scope of the RHC or FQHC benefit. When clinics and centers separately bill laboratory services, the cost of associated space, equipment, supplies, facility overhead and personnel for these services must be adjusted out of the RHC or FQHC cost report. This does not include venipuncture, which is included in the AIR when furnished in an RHC by an RHC practitioner or furnished incident to an RHC service, and it is included in the per-diem payment when furnished in an FQHC by an FQHC practitioner or furnished incident to an FQHC service.

Does this mean that we should be billing for labs on a CMS-1500 under the rendering provider's NPI instead of on a UB-04 under our FQHC's NPI since they are not FQHC services, and expect to get separate reimbursement? We have the billing staff insisting that all of our UnitedHealthcare should be billed out on UB-04 forms regardless of the services we are billing for.

Any assistance is greatly appreciated!

 

[Lori Roudenbush]

We are an FQHC in Idaho and we bill our Medicare Advantage plans exactly like we bill our Medicare claims. Labs must be billed on a 1500 claim form, except for the blood draws. We have been successfully paid for our labs from MC Advantage plans for a long time now. You should be following the same FQHC guidelines for Medicare Advantage plans that you do for your Medicare.

Lori Roudenbush, CPC, CPMA, CEMC