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Karen

Hattiesburg Posted Tue 07th of February, 2017 12:52:23 PM
We are a multi specialty clinic who has an independent laboratory. Some services are submitted to a reference laboratory to perform. We are billing with a 90 modifier on each line, block 32 of the 1500 claim form has the reference laboratory information, and our billing information in bock 33. We are including both our CLIA number and the reference laboratory CLIA number on the claim. We are receiving a Medicare denial of B7(provider is not eligible for payment on date of service). Per Medicare, the physician in block 31 of the 1500 claim form is not eligible to bill these services based on his specialty which is Pulmonary. Confused as to what information should be in block 31 of the 1500 claim form.
SuperCoder Answered Wed 08th of February, 2017 02:29:50 AM

You should not bill for the services. The reference laboratory will bill for the services. You would be mentioned as the referring provider in field 17. The reference laboratory will fill the details in field 31, 32 and 33 of HCFA 1500 form.  

Hattiesburg Posted Wed 08th of February, 2017 14:59:28 PM
What if the reference laboratory doesn't bill Medicare but we are buying the service from them. Can we bill Medicare for reimbursement in that scenario?
SuperCoder Answered Thu 09th of February, 2017 01:53:22 AM

As per coding guidelines, rendering provider should bill for the services. In your case, you are the referring provider and the rendering provider will get reimbursed for the services.

I suggest you to get in touch with your insurance company to check if they allow you to bill in place of the rendering provider. You would probably be asked to provide a documented agreement between you and the reference provider, where rendering provider would not be claming for the services. I hope this works or else the rendering provider would have to bill for the services.

Rendering provider should get himself enrolled in the Medicare Programme as the Billing provider.

Sharing an Medicaid link from Ohio state for more understanding:

http://medicaid.ohio.gov/Portals/0/Providers/Billing/TradingPartners/Forums/ORP-FAQs.pdf

 

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