In-house lab billing

dgarrett10

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Macon
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How is an in-house lab (Lab-Corp) set up in a Provider Based Physician Clinic. How is the billing done and CLIA, does lab-corp have to have their own CLIA number? Any help would be appreciated.
 

trarut

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Columbus, OH
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Depends on the arrangement with the lab company. We have a third-party lab who has space in our office and we do not bill for any lab services. They are responsible for all of their own billing & have their own ID numbers.
 

thomas7331

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How is an in-house lab (Lab-Corp) set up in a Provider Based Physician Clinic. How is the billing done and CLIA, does lab-corp have to have their own CLIA number? Any help would be appreciated.
Provider Based rules are complex and always changing, so I'm not sure if my information is still current. But as I recall, if your provider based clinic is on-campus and the facility is not a critical access hospital, then your facility will need to be billing the labs along with the rest of the facility fees on the UB-04 claim, even if they have an outside company performing the work.

As for the CLIA number - any location that performs lab tests is required to obtain its own CLIA certification.

But this is something that you should work out with your facility's leadership and compliance department - there are a lot of legal and administrative requirements involved in provider based billing and it's not something that can be properly addressed in forum posts like this - you need someone on site who is familiar with the facility and its payer contracts and local regulations to be able to guide you on this.
 
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Kristen Bensel

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I currently work in a facility where we have an in house lab we own- we bill for the labs we perform, not for tests that we send out to our reference lab. My previous employer however had an outside lab that a was embedded in the office and they were responsible for billing their own services. We only billed for the providers services.

As for the CLIA- if it is truly an outside company using the space in your office, they would have to be responsible for obtaining the appropriate CLIA's for the location. If your providers are going to own and perform the tests themselves, then they would at that point need to obtain the CLIA.
 

SharonCollachi

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How is an in-house lab (Lab-Corp) set up in a Provider Based Physician Clinic. How is the billing done and CLIA, does lab-corp have to have their own CLIA number? Any help would be appreciated.
If Lab Corp is your "in house lab", then they handle everything themselves. You don't get to bill for what they do.
 
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