What is an independent reference laboratory?
Independent reference laboratory Reference labs are usually private, commercial facilities that do high volume routine and specialty testing. Most of the tests performed are referred from physician's offices, hospitals, and other healthcare facilities like nursing homes.
What is the difference between reference lab and clinical lab?
Medicare defines a referred clinical diagnostic laboratory service/test as a service performed by one laboratory at the request of another laboratory. “Referring laboratory” is defined as the laboratory that refers a specimen to another laboratory for testing.
What is lab pass through billing?
Pass-through Billing: Pass-through billing schemes occur when a provider, such as a physician or hospital, pays a laboratory to perform their tests and then files the claims as though they had performed the tests themselves.
What place of service should an independent or reference laboratory report when billing?
A: When billing, the place of service reported should be the location where the specimen was obtained, For example, a specimen removed from a hospitalized patient and sent to the laboratory would be reported with (POS) 21 or 22; a sample taken at a physician's office and referred to the laboratory would be reported ...
What is another name for a reference laboratory?
a laboratory that performs reference or calibration measurement procedures or assigns reference values to test objects, later potentially providing those associated reference values for references or sources of traceability of test results; alternate names include: reference measurement, reference testing, and ...
What is modifier 90 used for?
Modifier 90 is used when laboratory procedures are performed by a party other than the treating or reporting physician and the laboratory bills the physician for the service. For example, the physician (in his office) orders a CBC, the physician draws the blood and sends the specimen to an outside laboratory.
Does Medicare allow pass-through billing?
3. Pass-through billing violates Stark Law and the Anti-Kickback Statute. In Medicare, Medicaid and federal payer cases, the service will not meet the “ancillary services exception” or safe harbor.
What is a Medicare pass-through payment?
For drugs and biologicals, the pass-through payment is the amount by which 95 percent of the average wholesale price exceeds the applicable fee schedule amount associated with the drug or biological.
What is CLIA number in medical billing?
The CLIA Number is issued by Cruise Lines International Association (hence, the acronym). In a nutshell, it's a way for vendors to identify you as a seller of travel. But I can tell you what a CLIA (Cruise Lines International Association) Number is, what it does, and what type of agents would benefit most from it.
What is the difference between a specific and a general profile and when is each ordered?
Profiles define the name and type of object to which the authorities will apply. A specific profile exactly matches the name of the object, while a generic profile matches one or more objects using wildcard characters.
Does Medicare cover diagnostic blood tests?
Medicare Part B covers outpatient blood tests ordered by a physician with a medically necessary diagnosis based on Medicare coverage guidelines. Examples would be screening blood tests to diagnose or manage a condition. Medicare Advantage, or Part C, plans also cover blood tests.
What is a 91 modifier used for?
Modifier 91 is defined by CPT® as representative of Repeat clinical diagnostic laboratory test, and is used to indicate when subsequent lab tests are performed on the same patient, on the same day in order to obtain new test data over the course of treatment.