• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Lab services for Home Health patients- covered/not covered by Medicare??


Best answers
Question: A client (independent lab) is working with an Assisted Living Facility to provide lab services to its residents. The ALF has stated that when their residents are under home health care, "they don't get paid for lab services".

Would laboratory services not be reimbursed by Medicare to an independent lab for performing various lab tests if ordered by a physician and the patient was receiving home health under a different physician? That doesn't sound right...

The ALF wouldn't be billing for the labs because they don't perform them, so I am not understanding what the ALF meant by they dont get paid..? Perhaps they meant the lab tests don't get paid, not referring to venipuncture?

The lab would be sending a phlebotomist to draw the labs and return them to the processing lab, which is independent of the physician and the ALF. Does Medicare only allow the patient to receive lab draws through the HHA and whoever the HHA is contracted with to perform the tests? If that's the case, how would Medicare know who the HHA uses for lab tests and to pay them, and them only?

Can someone please offer any insight into this scenario? I understand Consolidated billing for DMEs and supplies when it comes to HH, but I cannot find any information on laboratory testing and services in order to clarify the situation and whether the client can even market services in this situation.



True Blue
Atlanta, Ga.
Best answers
This is not my area of expertise, but I think that Medicare pays the ALF a flat rate per patient to cover ALL medical services required by that patient. The lab should be billing the ALF directly for its services. The cost of the labs becomes a cost of doing business for the ALF. I could be wrong, so I hope someone who is more knowledgeable about this situation will confirm or deny. In the meantime, check out the Medicare Claims processing manual online at CMS to see if it addresses this question.