AlaskanCoder
Guru
I am seeking some official references to use in convincing some of my providers about the illegality of billing Medicare patients for labs rather when sent out to an outside reference lab. This clinic does not have a contract with the outside reference lab to bill third party. Generally, they will send Medicare patients to the lab for any draws that are required. However, occasionally a Medicare patient refuses to go the lab or the provider feels that it is too much for some elderly, frail patients to have to go to the lab. The providers are convinced that all they have to do is say so and we can bill Medicare, or they think the secondary coverage will pick it up. I have explained that, when we bill Medicare, we will get a "CO" denial and have to write off the charges, we CANNOT by law bill the patient nor the secondary coverage.
They also think that an ABN will cover the issue for them, but, of course, it does not since the issue is that they are not following Medicare regulations. The ABN would only cover the medical necessity denial for the lab (a lot of the tests are pure screening labs and not medically necessary.)
Does anyone have a link or other documentation that I can provide to this clinic to prove to them that they cannot bill the patient for labs that billed by the office who does not have the appropriate CLIA certification and the labs are run by an outside reference lab?
Thank you in advance,
Karen
They also think that an ABN will cover the issue for them, but, of course, it does not since the issue is that they are not following Medicare regulations. The ABN would only cover the medical necessity denial for the lab (a lot of the tests are pure screening labs and not medically necessary.)
Does anyone have a link or other documentation that I can provide to this clinic to prove to them that they cannot bill the patient for labs that billed by the office who does not have the appropriate CLIA certification and the labs are run by an outside reference lab?
Thank you in advance,
Karen