Medicare Improvements for Patients and Providers Act of 2008: Legislative Change to Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services
MLN Matters Number: MM6042
Related Change Request (CR) #: 6042
Related CR Release Date: July 25, 2008
Effective Date: July 1, 2008
Related CR Transmittal #: R1561CP
Implementation Date: August 25, 2008
Provider Types Affected
Independent laboratories billing Medicare Carriers or Medicare Administrative Contractors (MACs) for services rendered to hospitalized Medicare beneficiaries.
Impact on Providers
Qualifying independent laboratories may continue to bill Medicare directly for the TC of certain physician pathology services provided to patients as part of a covered hospital inpatient stay or outpatient hospital service, through December 31, 2009 regardless of the beneficiary’s hospitalization status, in accordance with the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).
CR 6042 also instructs the carriers/MACs not to implement the business requirements of CR 5347 with respect to action for physician pathology services (See MLN Matters article, MM 5347, at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5347.pdf. (CR 5347 prevents payment by a carrier for a TC of a pathology service rendered during an inpatient stay or for the same date of service (DOS) as an outpatient service. CR 6042 negates that directive to carriers/MACs.)
Background
As a result of MIPPA, CR 6042 instructs the carriers/MACs to notify the independent laboratories that those that qualify to bill under the Section 542 of the Benefits Improvement and Protection Act of 2000 (BIPA)/Section 732 of the Medicare Modernization Act (MMA)/ Section 104 of the Tax Relief and Health Care Act of 2006 (TRHCA)/ Section 104 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) for the TC of the physician pathology services may continue to do so effective with DOS July 1, 2008 through December 31, 2009. This is an additional eighteen (18) months beyond the expiration date in the MMSEA.
Additional Information
To see the official instruction (CR 6042) issued to your Medicare Carrier or A/B MAC visit http://www.cms.hhs.gov/Transmittals/downloads/R1561CP.pdf.
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Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.