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).

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 16