Tuesday, May 10, 2016

Pathology service under ASC setup - Would insurance reimburse

Non-ASC Facility Services

Non-ASC facility services include a number of items and services furnished in an ASC that can be reimbursed under other Florida Workers’ Compensation Manuals which are not reimbursable to an ASC facility.

The following are examples of non-ASC facility services that must be billed and reimbursed to those providers under other Florida Workers’ Compensation Reimbursement Manual policies and guidelines:

• Physician and other recognized health care practitioner services;

• Sale, lease, or rental of durable medical equipment for ASC patients to use at home;

• Services furnished by an independent laboratory; and

• Hospital-based Ambulance services.

Pathology/Laboratory Services

Preadmission pathology or laboratory services, when required by the physician and performed by the ASC on a date other than the date of surgery, shall be reimbursed in accordance with the Fee Schedule established for health care providers in the Florida Workers Compensation Health Care Provider Reimbursement Manual, Rule 69L-7.020, F.A.C.

Pathology or laboratory services provided by an Independent Clinical Laboratory shall be billed and reimbursed directly to the laboratory service provider according to the fee schedule in rule 69L-7.020, F.A.C. However, the ASC shall be reimbursed for procedure code 36415 for the collection of a blood specimen that must be conveyed to an independent laboratory.

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