How to Bill Medicare for Lab Work
Dealing with medical claims is never fun. But thanks to the simple-to-use Medicare website and claims processing system, you can submit your claim online or contact Medicare and have a claims specialist walk you through the process. It is important to note that, in most cases, you are not required to file a claim for laboratory tests, as the laboratory will bill Medicare on your behalf. However, if an outside lab is used or the laboratory bill is not sent to Medicare, learn what options are available.
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Instructions
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Know what laboratory, diagnostic and X-ray tests are covered under Medicare Part B.
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Understand that all medical services billed under Medicare Part A are considered voluntary and are subject to a 20 percent co-payment, excluding some outpatient clinical laboratory services.
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Know that most laboratory tests are paid from the Medicare Laboratory Fee Schedule; services that are listed on the schedule are not subject to co-payment fees and should not produce a bill.
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Verify that the laboratory test is covered. Obtain the procedural code to verify eligibility.
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Wait for the laboratory or physician performing the service to bill Medicare. Direct billing is mandatory for Medicare-reimbursed laboratory tests; the insured does not have to bill Medicare for laboratory tests.
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Follow up with Medicare to verify that the bill was received and paid. Contact the laboratory facility to confirm receipt of payment.
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Bill Medicare for laboratory tests that were referred to an outside hospital or "reference" laboratory.
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Go to the Medicare.org website or call 1 (800) Medicare to file a claim for the laboratory test(s). File the claim within 15 to 27 months of having the laboratory tests performed.
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Download the form. Provide the name and address of your primary physician, the name of the physician who referred you or the specimen to the laboratory for testing, the date the laboratory test was complete, as well as your full legal name, policy number and address.
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Tips & Warnings
Contact Medicare for billing questions.
This article should only be used for educational purposes.
