A new program transmittal from the Centers for Medicare and Medicaid Services updates the Internet-only manual instructions regarding how the technical component (TC) of pathology services should be billed for hospital inpatients and outpatients. Program transmittal R2714CP communicates revisions to chapters 12 and 16 of the Medicare Claims Processing Manual to update billing and claims processing instructions contained in the manual for billing the TC and professional component (PC) of physician pathology services furnished to hospital patients. Specifically, the transmittal makes it clear that an independent laboratory may not bill Medicare contractors directly for the TC of a physician pathology service furnished to a hospital inpatient or outpatient; it must bill such services to the hospital. The transmittal comes almost one year after its effective date, July 1, 2012. The effect of the transmittal may be that it effectively eliminates global billing for these services for Medicare patients. Anatomic pathology laboratories frequently misunderstand the principles governing global billing and file claims incorrectly. It is important to remember that if a modifier is not used when submitting claims for the separate TC and PC services of anatomic pathology claims, the services will be considered a global service. Global billing essentially means […]
A new program transmittal from the Centers for Medicare and Medicaid Services updates the Internet-only manual instructions regarding how the technical component (TC) of pathology services should be billed for hospital inpatients and outpatients. Program transmittal R2714CP communicates revisions to chapters 12 and 16 of the Medicare Claims Processing Manual to update billing and claims processing instructions contained in the manual for billing the TC and professional component (PC) of physician pathology services furnished to hospital patients. Specifically, the transmittal makes it clear that an independent laboratory may not bill Medicare contractors directly for the TC of a physician pathology service furnished to a hospital inpatient or outpatient; it must bill such services to the hospital. The transmittal comes almost one year after its effective date, July 1, 2012. The effect of the transmittal may be that it effectively eliminates global billing for these services for Medicare patients. Anatomic pathology laboratories frequently misunderstand the principles governing global billing and file claims incorrectly. It is important to remember that if a modifier is not used when submitting claims for the separate TC and PC services of anatomic pathology claims, the services will be considered a global service. Global billing essentially means filing a single claim for a service that includes both its TC and PC. Billing globally for anatomic pathology services is only possible when both components are furnished by the same physician or supplier entity. If the TC and PC are provided in different locations, they must be billed separately and must include the appropriate modifier for each service. Anatomic pathology laboratories and hospital laboratories should review their billing processes to ensure they are billing appropriately. The new manual instructions are a good reminder that merely applying the same place of service code does not permit global billing.
