All Entries Tagged With: "CAH"
Critical access hospitals and billing for non-patient laboratory testing
In a May 12 post, clarification was given regarding a “non-patient” and reference laboratory testing. Continuing with this discussion, critical access hospitals (CAH) also received good news in Transmittal 1729 to the Claims Processing Manual, dated May 8, 2009. Under Section 148 of MIPPA (Medicare Improvements for Patients and Providers Act), a CAH will be paid 101% of reasonable cost for outpatient clinical diagnostic laboratory tests for those patients who are not physically present in the CAH at the time the specimen is collected. These patients are referred to as “non-patients” since only a specimen is received for the date of service. Prior to this transmittal, all hospitals providing laboratory services to “non-patients” were instructed to bill on Type of Bill (TOB) 14X which triggered reimbursement under the Clinical Laboratory Fee Schedule. [more]
Clarification of reference (non-patient) laboratory testing
CMS released Transmittal 1729 to the Claims Processing Manual this week, implementing provisions of the Medicare Improvements for Patients and Providers Act (MIPPA) regarding payment of reference laboratory tests performed at a Critical Access Hospital (CAH). Although directed at CAHs, this is a good opportunity to review the rules for reference lab billing for OPPS hospitals as well. This is a common area of confusion for hospitals because of the definition of non-patient in the context of reference lab services. See Claims Processing Manual, Chapter 16, Section 40.3, as revised by Transmittal 1729, and Benefit Policy Manual, Chapter 6, Section 70.5. [more]
