Avoid Disruption in Medicare Reimbursement When Changing Level of Lab Complexity - DoctorsManagement Avoid Disruption in Medicare Reimbursement When Changing Level of Lab Complexity - DoctorsManagement

Avoid Disruption in Medicare Reimbursement When Changing Level of Lab Complexity

When moving a lab from waived testing to non-waived, Medicare has to be notified on form 855I or B (click to download PDF) of the change in complexity before Medicare will start reimbursing for non-waived testing. Also attach the Certificate of Registration from your state’s CLIA office for full disclosure.

This certificate takes about six weeks to obtain, and once you have possession of it, you are usually allowed to begin testing the non-waived menu (in approving states). It is at that time that the notification to Medicare can be carried out. Medicare allows a practice to re-submit any billing in the past 30 days that might have been denied due to the wait for the Medicare to update.

Many physician office laboratories think that the gap is lost revenue, but the good news is that you can re-submit for the previous 30 days.

As always, contact us via email or call 800-635-4040 with any questions or concerns.

If you have questions about this topic or any other issues around the business of medicine, contact us via email or call us at 800-635-4040.