Outpatient PPS at a glance
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- Professional components of pathology physician services remain
separately billable to the local Part B Medicare carrier (no change
to current status).
- Independent laboratories that provide the technical component
of pathology physician services to registered hospital outpatients
will have to bill the hospital for the TCs beginning Aug. 1. The
hospital will be paid for the TCs by the Part A intermediary,
using the PPS ambulatory payment classifications system.
- Independent laboratories that provide clinical diagnostic laboratory
services to registered hospital outpatients will continue to have
to bill the hospital for the services. But the tests remain payable
to the hospital under the Medicare clinical laboratory fee schedule
and are not bundled into the PPS APCs.
- A registered hospital outpatient is a person who has not been
admitted as an inpatient but who is registered on the hospital
records as an outpatient and receives services (rather than supplies
alone) directly from the hospital.