Clinical Laboratory:
A Clinical laboratory or Medical laboratory is a laboratory where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment and prevention of disease
A diagnostic laboratory test is considered a laboratory service for billing purposes, regardless of whether it is performed in:
A physician's office by an independent laboratory;
By a hospital laboratory for its outpatients or non patients;
In a rural health clinic; or
In an HMO or Health Care Prepayment Plan (HCPP) for a patient who is not a member.
Revenue Cycle Management Solutions for Laboratory Billing:
VeeBill- a premier outsourced revenue cycle management service, helps to enhance your collection performance with front-end claims editing, significant rules engines, advanced business intelligence tools, and experienced client management for strategic planning capability.
VeeBill understands that clinical and diagnostics laboratories face a number of internal challenges in terms of Billing and Financial operations, mounting regulatory demands, inadequate legacy applications.
VeeBill take complete control on your lab revenue to drive turnover, efficiency with minimal stress.
Understand the need of the hour of the Clinical Laboratories, VeeBill has built a plat form for maximizing the collections and decreasing operating cost of the laboratories.
RCM work flow:
Laboratory Claims Information and Claim forms:
Claims for referred laboratory services may be made only by suppliers having specialty code 69, i.e., independent clinical laboratories. Claims for referred laboratory services made by other entities will be returned as unprocessable.
Independent laboratories shall use modifier 90 to identify all referred laboratory services. A claim for a referred laboratory service that does not contain the modifier 90 is returned as unprocessable if the claim can otherwise be identified as being for a referred service.
The name, address, and CLIA number of both the referring laboratory and the reference laboratory shall be reported on the claim.
Paper Claim Submission to Carriers
An independent clinical laboratory that elects to file a paper claim form shall file Form CMS-1500 for a referred laboratory service (as it would any laboratory service). The line item services must be submitted with a modifier 90.
Billing
The CLIA number is required in field 23 of the paper Form CMS-1500. The electronic formats have a field
CLIA Numbers
The structure of the CLIA number follows:
Positions 1 and 2 contain the State code (based on the laboratory's physical location at time of registration);
Position 3 contains the letter .D"; and
Positions 4-10 contain the unique CLIA system assigned number that identifies the laboratory. (No other laboratory in the country has this number.)
Independent dialysis facilities must obtain a CLIA certificate in order to perform clotting time tests.
Physician Notification of Denials
If there is no CLIA number on the claim, the carrier sends RA messages MA 120 and MA 130, which state:
MA 120 - Did not complete or enter accurately the CLIA number.
MA 130 - Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim in unprocessable. Please submit the correct information to the appropriate FI or carrier
When coding individual clinical laboratory procedures, the following coding rules apply:
(a) Select the name of the procedure that most accurately identifies the service being performed. The listing of a procedure under a particular specialty in the CPT does not restrict its use to that specific specialty.
(b) When a procedure for a specific analytic is not listed, use the method code that most accurately identifies the procedure used. As a last resort, use an unlisted service code (those ending in 99) plus appropriate description of the procedure.
(c) Procedures that include multiple tests may not be "unbundled" into component procedures. Unbundling is considered an abusive practice by Medicare.
(d) Multiple codes may be used to describe a single panel or profile so long as the unbundling rule is not violated.
(e) Unless otherwise specified, laboratory procedures are assumed to be quantitative.
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