Laboratory Question for the Week of May 23, 2016

Laboratory Compliance Question of the Week

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.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.