BC Advantage - 2016 Issue 5

Pass-Through Billing and Shared Labs

Pass-through billing has mostly passed on.Pass-through billing is an arrangement between a physician practice and a reference laboratory that allows the physician practice to submit specimens to the reference lab for testing, pay that laboratory directly, and then bill the payer (insurance or patient) for the test, usually at a higher fee. This practice, in which the physician makes a profit for work done by another entity, is prohibited by Medicare and Medicaid.CMS requires all laboratory tests to be billed by the laboratory that does the work. Some states and some private payers have similar restrictions. Examples...

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