HCPro, JustCoding Outpatient - 2015 Issue 31 (August)
Healthcare News: CMS proposes changes to lab reporting in 2016 OPPS proposed rule
August 19th, 2015
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Article Overview
This article summarizes a CMS proposal in the CY 2016 OPPS proposed rule that would change how laboratory tests are reported and paid on outpatient claims. It is relevant to hospital outpatient departments, coding and billing staff, and compliance teams that handle CLFS-related claims processing, modifier reporting, and lab payment policy updates. The discussion also covers proposed treatment of molecular pathology services and preventive laboratory tests.
Why This Topic Matters
The proposal could affect claim reporting workflow, administrative burden, and how certain laboratory services are handled for separate payment in outpatient settings. It is important for organizations that submit multi-service or multi-day hospital outpatient claims and need to track policy changes affecting lab payment and claim editing.
What You Will Learn
- How CMS proposed to change outpatient laboratory test reporting in the 2016 OPPS proposed rule
- The role of status indicators in claim processing for laboratory services
- How modifier reporting was proposed to change for certain laboratory tests
- Which categories of laboratory services were discussed for separate payment under the CLFS
- How the proposal could affect outpatient claim reporting workflows
Who Should Read This
- Hospital outpatient billing staff
- Medical coders
- Coding auditors
- Revenue cycle teams
- Compliance professionals
Codes Discussed
Modifiers Discussed
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