decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Answer_Book / Laboratory_Services_Clinical / How_to_bill_for_automated_profiles
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Article Overview
This laboratory billing article is for coders, billers, and compliance staff who need to understand how automated test profiles and panels are recognized for Medicare claims. It discusses general CMS policy on panel billing and provides a reference table showing which chemistry tests are associated with common panel groupings, helping readers evaluate whether claims are being submitted at the individual-test level or as a bundled panel.
Why This Topic Matters
Laboratory claims can be paid differently depending on whether tests are billed individually or as a defined panel. Understanding the article helps avoid claim processing problems and supports accurate reporting for common chemistry profiles.
Article Sections
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CMS policy on profiles and panels
Explains the general Medicare concept of a laboratory profile or panel and the claims-processing issue addressed in the article. It also introduces the policy context for the reference material that follows.
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Chemistry panel reference table
Provides a cross-reference of common chemistry tests against several standard panel groupings. The table is intended to help readers compare individual test billing with bundled laboratory panel reporting.
What You Will Learn
- How CMS generally treats laboratory profiles and panels
- Why automated panel claims may not process the same way as individual test claims
- How to use a chemistry cross-reference table for panel-related billing review
- Which common laboratory tests are associated with standard chemistry groupings
Who Should Read This
- Medical coders
- Laboratory billers
- Revenue cycle staff
- Compliance professionals
- Coding auditors
Codes Discussed
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