And, in general, the date of service on a hospital’s Medicare claim for clinical laboratory tests is the date of specimen collection.
Under a new rule that went into effect on January 1, 2018, the date of service on a claim for certain ADLT and molecular pathology tests that are excluded from the hospital outpatient prospective payment must be the date the test was performed.
Although CMS has not yet designated any tests as ADLTs, it is critical for facilities to begin working through operational and reference lab contracting issues to implement the required changes for molecular pathology tests.
These tests are paid separately under the Clinical Laboratory Fee Schedule (CLFS) rate and are not packaged into outpatient hospital Ambulatory Payment Classification (APC) payment rates, even when they are performed on the same date of service and/or billed on the same outpatient claim.
This list is taken from the Parallel Table of Authorities and Rules provided by GPO [Government Printing Office].
It is not guaranteed to be accurate or up-to-date, though we do refresh the database weekly.
Rinkle, MPA, is a lead regulatory specialist and instructor for HCPro's Revenue Integrity and Chargemaster Boot Camp®, as well as an instructor for HCPro’s Medicare Boot Camp®—Hospital Version and Medicare Boot Camp®—Utilization Review Version.
Rinkle is a former hospital revenue cycle director and has over 30 years in the healthcare industry, including over 12 years of consulting experience in which she has spoken and advised on effective operational solutions for compliance with Medicare coverage, payment, and coding regulations.
She has more than 20 years of broad healthcare experience and deep expertise in clinical laboratory operations.
means a code for which there has been a substantive change to the definition of the test or procedure to which the code applies (such as a new analyte or a new methodology for measuring an existing analyte specific test).
for purposes of an ADLT, means a single laboratory, that has assumed ownership of the single laboratory that designed the test or of the single laboratory that is a successor owner to the single laboratory that designed the test, through any of the following circumstances: The merger of the single laboratory corporation into another corporation, or the consolidation of two or more corporations, including the single laboratory, resulting in the creation of a new corporation.
During this webinar, experts Valerie Rinkle, MPA, and Laura Lindeman-Lorenz, JD, MHA, MT(ASCP), will review CMS’ current hospital “prohibition of unbundling hospital services” rules as well as the current laboratory DOS policies.
They will also explain how to bill for outpatient molecular pathology tests and discuss the differences in inpatient and outpatient billing for these tests.