decisionhealth Newsletters, Part B News - 2008 Issue 12 (December)
Carriers can no longer reject claims for not checking box 20
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Article Overview
This article explains a Medicare claims-processing change affecting how carriers respond when a professional claim does not show whether an outside lab was used. It is relevant to billing and coding staff, compliance teams, and providers who submit diagnostic and imaging claims, because it discusses CMS guidance, claim processing, and the risk of payment errors tied to missing claim information.
Why This Topic Matters
The topic matters because it affects claim acceptance and the handling of diagnostic services when an outside laboratory or diagnostic testing facility is involved. It also highlights the ongoing need to report purchased technical component information accurately to avoid incorrect payment or overpayment issues.
What You Will Learn
- How CMS updated carrier handling of claims when outside-lab information is missing
- Why reporting purchased diagnostic technical component information remains important
- What types of diagnostic and imaging claim scenarios are affected by the guidance
- How the update relates to Medicare claims-processing requirements
Who Should Read This
- Professional coders
- Billing staff
- Compliance staff
- Practice managers
- Physicians and other providers
- Healthcare consultants
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