decisionhealth Newsletters, Answer Books - 2006 Issue 7 (July)
Medicare_Claims_Processing_Manual / Chapter_1 / 30.2.9
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Article Overview
This article explains Medicare claims-processing guidance for purchased diagnostic tests submitted to carriers. It focuses on payment handling, claim submission format, service-location reporting, and when claims are considered unprocessable. The material is intended for physicians, medical groups, billing staff, and other Medicare claims professionals who need to understand how purchased diagnostic services are processed under the Medicare Claims Processing Manual.
Why This Topic Matters
Purchased diagnostic test claims have specific Medicare billing and formatting requirements that affect whether a claim can be paid or rejected. Understanding these rules helps providers and billing teams submit compliant claims and avoid unprocessable submissions.
Article Sections
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Payment to Physician for Purchased Diagnostic Tests
Overview of Medicare payment handling for purchased diagnostic tests submitted to carriers. The section discusses who may submit the claim, general payment conditions, and related enrollment and assignment considerations.
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Billing and Claim Submission Requirements Effective April 1, 2004
Submission rules for paper and electronic claims with purchased diagnostic tests. The section addresses claim formatting, service-location information, and how carriers should treat claims that do not meet the required submission structure.
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Global Billing Limitations for Purchased Services
Guidance on separate line-item billing versus global billing for purchased services. The section explains how claims should be processed when purchased testing is identified on the claim.
What You Will Learn
- How Medicare handles claims for purchased diagnostic tests submitted to carriers
- What broad claim submission requirements apply to paper and electronic formats
- What general processing issues can cause a claim to be treated as unprocessable
- How billing structure affects claim pricing and payment handling
Who Should Read This
- Physicians
- Medical groups
- Billing and coding staff
- Medicare claims processors
- Revenue cycle professionals
Codes Discussed
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