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March 27, 2018

Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More

Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More

OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More

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Independent Laboratories Not to Receive Medicare Payments

July 22, 2008:
Billing of the technical portion of pathology services has just gotten simpler—or more complex—depending on which side of the fence you are on. As of June 30, independent laboratories will no longer be paid separately by Medicare for services performed for a hospitalized patient, either in- or outpatient.

An original provision of the 2000 final rule allowed the technical component of pathology services to be reported only by a hospital or facility for both in- and outpatients. A later provision allowed a temporary continuation for independent laboratories with formal arrangements for providing and billing the pathology services effective before July 22, 1999, to report the TC, or technical component, of a pathology service. This provision was extended to June 30, 2008, but will not be continued.

The Centers for Medicare and Medicaid Services (CMS) has determined that, in the past, the technical portion of physician pathology services performed by an independent laboratory on hospitalized patients has been reimbursed twice, once to the independent laboratory under the Medicare physician fee schedule, and once to the facility. As of July 1, 2008, Medicare will consider the technical portion of pathology services to be part of the hospital or facility billing and will not allow an independent laboratory to bill for these services separately.

Hospitals that previously outsourced the TC portion of pathology services will now be required to report this function since it will be bundled into the facility reimbursement.

Nannette Orme, CPC-E/M, PCS
Clinical/Technical Editor


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