Physicians - Are You Submitting Claims for a Laboratory Test You Sent to an Outside Laboratory?
Physicians can only bill Medicare for the clinical laboratory tests they actually perform. The clinical laboratory must bill for the tests they perform. Medicare will recover the overpayment from the physician for services not performed in the physician's laboratory. Correcting inappropriate payment is very labor intensive for both the contractor and the physician office. Some of the activities include requesting documentation from the physician's office, evaluating the documentation from both the physician and laboratory, requesting the incorrect payment from the physician, and reimbursing the laboratory for the services performed. Physician offices billing for clinical lab services they do not perform could constitute fraudulent billing.
You can find more information in the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Pub. 100-04, Chapter 16, Section 50.2 
and Chapter 13, Section 20.2.4.2 .
Page Last Updated: Thursday, 18-Mar-2010 05:56:28 CDT
