BILLING NEWS

Redefined Type of Bill

Medicare will implement a redefined Type of Bill (TOB) 14x to avoid overpayment for lab services furnished to non-patients. Any hospital (including a Critical Access Hospital (CAH)) receiving such specimens is to bill for the lab test on a TOB 14x.

Lab services performed for non-patients by a CAH or a hospital subject to a state of Maryland waiver, will be paid on the Part B clinical diagnostic lab fee schedule.

Since the definition of 14x was changed, in the early 1990s, to be for “all referred diagnostic services”, CMS lost the ability to differentiate between the lab specimens of outpatients and of non-patients. Consequently, TOB 14x could not be used to drive differential payment. The change is being implement due to the need to distinguish between outpatients and non-patients for certain pathology tests, and an upcoming demonstration project that will only apply to non-patients.


INDUSTRY NEWS TAGS: CMS


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