Sunday, February 6, 2011

ASC billing lab procedure - Referring physician detail is must

If the ASC has its laboratory certified, the laboratory itself may bill for the tests performed.

The ASC may make arrangements with an independent laboratory or other laboratory, such as a hospital laboratory, to perform the diagnostic tests it requires prior to surgery. In general, however, the necessary laboratory tests are done outside the ASC prior to scheduling of surgery, since the test results often determine whether the beneficiary should have the surgery done on an outpatient basis in the first place.

Beginning January 1, 2009, the ordering/referring physician must be reported on claims for diagnostic services submitted by the ASC.

Administrative, Recordkeeping and Housekeeping Items and Services
Administrative, recordkeeping and housekeeping items and services include the general administrative functions necessary to run the facility, e.g., scheduling, cleaning, utilities and rent.
Blood, Blood Plasma, Platelets, Etc., Except Those to Which Blood Deductible Applies
While covered procedures are limited to those not expected to result in extensive loss of blood, in some cases, blood or blood products are required. Usually the blood deductible results in no expenses for blood or blood products being included under this provision. However, when there is a need for blood or blood products beyond the deductible, they are considered ASC facility services and no separate charge is permitted to the beneficiary or the program.

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