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HCFA responds
Back to Feature Story
July 2000
Sidebar
The following is the Health Care Financing Administration’s response
to a College request for clarification of the independent laboratory
technical component billing issue under the hospital outpatient prospective
payment system. Janet Wellham, who provided this reply, is the HCFA
official responsible for Medicare outpatient PPS payment policies:
"An independent laboratory will not be able to bill for
the technical component of a pathology service under the outpatient
PPS. The outpatient final rule requires that the hospital must provide
directly or under arrangements all services furnished to hospital
outpatients. Therefore, if a specimen (e.g. tissue, blood, urine)
is taken from a hospital outpatient, the facility (or technical)
component of [a] diagnostic test must be billed by the hospital.
Only in cases where the patient leaves the hospital and obtains
the service elsewhere is the hospital not required to bill for the
service."
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