Question:
If a billing provider submits a claim for referred clinical laboratory and imaging services from a provider located outside of the United States will the claim be denied?
Answer:
Yes, the claim will deny because the referring provider who is located outside of the United State is ineligible to enroll in Medicare. The Centers for Medicare & Medicaid Services (CMS) remind billing providers that claims denied because they failed the ordering/referring edit do not expose a Medicare beneficiary to liability, and an advance beneficiary notice (ABN) is not appropriate in this situation.