hsmith67
Guru
Any assistance to help with a debate is greatly appreciated. Some of the questions may seem ridiculous, but I'm trying to resolve a debate.
Scenario:
20+ locations of a primary/urgent care business crossing state lines. High complexity CLIA certificate at a location in state "X" where high complexity labs are run. This location is not solely a "lab", patients are seen at this physical address as well with professional claims submitted for this location. Locations from state "X" and state "Y" collect specimens and forward to the location where the lab equipment is and the tests are run. For billing purposes, what should go in the following fields of a HCFA:
Box 17 Referring provider: Provider requesting the lab to be done that saw the patient and where specimen was collected or someone else?
Box 24 B Place of Service: 11 or 81? (remember, this address also submits professional claims with POS 11)
Box 24 J: MD at the location where test is run with High Complexity CLIA or someone else (e.g., clinical lab director)
Box 32 Service Facility: Facility where test was performed/attached to High Complexity CLIA or something else?
A concern that has been brought up is that if we use POS 11 for the claims submitted for the lab the payers will kick it back/deny as the patient was seen the same day in another state for an office visit/E&M and that is not possible for the patient to be seen in two states on the same date of service (using date of collection as DOS for the lab).
Thanks,
Hunter Smith, CPC
Scenario:
20+ locations of a primary/urgent care business crossing state lines. High complexity CLIA certificate at a location in state "X" where high complexity labs are run. This location is not solely a "lab", patients are seen at this physical address as well with professional claims submitted for this location. Locations from state "X" and state "Y" collect specimens and forward to the location where the lab equipment is and the tests are run. For billing purposes, what should go in the following fields of a HCFA:
Box 17 Referring provider: Provider requesting the lab to be done that saw the patient and where specimen was collected or someone else?
Box 24 B Place of Service: 11 or 81? (remember, this address also submits professional claims with POS 11)
Box 24 J: MD at the location where test is run with High Complexity CLIA or someone else (e.g., clinical lab director)
Box 32 Service Facility: Facility where test was performed/attached to High Complexity CLIA or something else?
A concern that has been brought up is that if we use POS 11 for the claims submitted for the lab the payers will kick it back/deny as the patient was seen the same day in another state for an office visit/E&M and that is not possible for the patient to be seen in two states on the same date of service (using date of collection as DOS for the lab).
Thanks,
Hunter Smith, CPC