Health Information Management

Pay-per-view: Billing labs with CMS’ new modifier

APCs Insider, October 17, 2014

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Over the past 15 years, CMS has refined its understanding of and commitment to OPPS as a prospective payment system—period—and not as fee-schedule driven, with separate payment made for each coded line item. Beginning in 2014, CMS finalized one of the most aggressive packaging policies under OPPS history—laboratory testing—making good on that goal.
Later in 2014, CMS published further instructions regarding when laboratory tests are paid separately and ultimately packaged in Transmittal 2971 and MLN Matters SE1412. Beginning with dates of service on or after July 1, CMS requires appending modifier -L1 to assist with revenue cycle operations and securing separate payment from CMS when stated provisions are met.
Continue reading To be or not to be: Billing labs with CMS' new modifier on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the October issue.

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