Laboratory Question for the Week of June 19, 2017

Question:

Does CMS permit a hospital to bill for lab services delivered to an ESRD patient?

Answer:

According to Medicare policy, the end-stage renal disease (ESRD) prospective payment system (PPS) includes consolidated billing (CB) for limited Part B services, which are included in the ESRD facility’s bundled payment. Certain lab services and limited drugs and supplies are subject to the Part B CB and are not separately payable by Medicare when they are provided for ESRD beneficiaries by providers other than the renal dialysis facility. When other providers do bill these lab services, Medicare will reject or deny the claim.

However, in the event that a lab service was furnished to an ESRD beneficiary for reasons other than for the treatment of ESRD, the provider may submit a claim for separate payment using modifier AY.

For more on this policy, go to https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MedQtrlyComp-Newsletter-ICN909435.pdf.