ED Coding & Reimbursement Alert - 2012 Issue 8
Reader Question: Know When to Apply Anti-Markup Rule
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Article Overview
This reader Q&A discusses Medicare billing policy for services obtained from outside laboratories and the related anti-markup rule. It is aimed at physician practices, surgical groups, pathology-related billing staff, and coders who handle claim preparation and compliance. The article provides general guidance on claim reporting, purchased service situations, and how these issues can affect billing across payers.
Why This Topic Matters
Understanding when the anti-markup rule applies helps billing teams avoid claim submission errors and maintain compliance with Medicare reporting requirements. It also addresses practical concerns about charge reporting and coordination of billing practices across different payer arrangements.
What You Will Learn
- The Medicare policy framework discussed for purchased diagnostic services
- How the anti-markup rule relates to claim reporting
- General considerations for reporting purchased services on a claim
- How billing responsibilities may differ based on the type of physician and service arrangement
- Why charge reporting for purchased services can affect billing workflows
Who Should Read This
- Physician billing staff
- Medical coders
- Practice managers
- Pathology billing personnel
- Compliance staff
- Surgical group administrators
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