AMA, AHA, DecisionHealth, HCPro, The Coding Institute and more Search current and archived editions Linked to and from code details
Carrier Claims Processing - Hospital Laboratory Services Furnished to Nonhospital Patients (Rev. 3014, Effective: Upon Implementation of ICD-10)
by Jared Staheli July 9th, 2015
When a hospital laboratory performs a laboratory service for a non-hospital patient, (i.e., for neither an inpatient nor an outpatient), the hospital bills its A/B MAC (A) on the ASC X12 837 institutional claim format or on the hard copy Form CMS-1450. If an A/B MAC (B) receives such claims, the A/B MAC (B) should deny them. When the lab services are provided in Maryland, services to a hospital’s own outpatients are paid under the State cost containment system. A Maryland hospital cannot seek payment based on a percent of charges for tests provided to individuals in locations such as a rural health clinic (RHC), a provider-based HHA, the individual’s home or a physician’s office). Individuals in these locations are non-patients of the Maryland hospital and their lab tests would be categorized as “non-patient specimen only lab tests” (TOB 14x), and are paid under the lab fee schedule.
When a hospital-leased laboratory performs a service for a non-hospital patient, it must bill the A/B MAC (B).
Article Tags (click on a tag to see related articles)
Publish this Article on your Website, Blog or Newsletter
This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.
If you would like a specific article written on a medical coding and billing topic, please Contact Us.
contact
innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
Email: