Billing CLIA Waived Tests
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- เผยแพร่เมื่อ 5 ต.ค. 2024
- When a practice has a CLIA Certificate of Waiver, special lab tests can be run in-house based on the CDC and FDA approval. These labs can be and should be billed for on claims. There are some data requirements on claims for these labs to be paid for by insurance. This video will explain what needs to be on claims and how to ensure the information is always on them.
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First, I want to thank you for the very detailed and specific information. Second, I want to know if Medicare Part B pays for the CLIA wave testing with modifier QW? Thank you
Thank you for watching. I’m glad you’ve found it helpful! Yes they do and they have a separate fee schedule for labs they pay for that you can find on their website. Good luck!
Hey, What actions can be take if we received denial as CLIA Certification level not met?
Good question. I would first check to see if the lab CPT code used on the claim itself is the correct code for the test. There are many tests out there and they can get confusing between point of care tests and serum tests ran in a big lab like Quest or Lab Corp. Secondly, see if the correct CPT code requires the "QW" modifier. If it does, make sure the "QW" modifier was on the claim with the CPT. If all of this is correct, then chances are you are probably doing a test that a CLIA Waived certificate does not cover and you need a higher CLIA certificate. Contact the manufacturer of the machine that makes the test, or reach-out to the rep who sold it to you, and ask if they know which CLIA you need. You can also look this up on the CLIA website or email someone there to find-out. Unfortunately, if you are performing and billing for tests not covered by your CLIA level certificate, chances are the insurances will not reconsider and you will eat the cost. I would stop performing and billing for the test until your certificate is correct for it. I am curious what you will find-out- please update me. Good luck and thanks for watching!
I have a question, our Clia Waived Testing machine does 3 test at once, it does Flu, RSV and Covid together at once, so can I bill all those test separately or i can only bill them as one test even though each tests have different CPT code.
If memory serves, there should be a code that includes all 3, from a machine (87637 ??- definitely look at the definition). Your manufacturer or rep where you bought the machine should be able to assist with this as well. The one CPT code would charge appropriately for all 3 and make it way easier.
If there is not just one CPT to incorporate all 3 in 1, then you would bill for each individual test. For example, clinics who test patients for influenza A and B using a rapid in-house POC test, can bill the same code twice, using an appropriate modifier on the second code listed, even though it was just "one" device/test that provided the results. You are still testing for both influenza A and influenza B.
Hopefully you can get this figured out quickly so you can make sure you are not underbilling for this.\
Thanks for the question and for watching!
I have a question I have my own independent lab CLIA waived, and I'm so confused because I have people that want to hire me to do home draws and long-term care facilities but are not sure how to build for the test. I do have a draw station also and some test I will be doing but say I perform a venous blood draw for a patient and the doctor send me the requisitions I do not know to build medicare part B or do the provider is billed?
I can see how that is confusing. Although I don't know the entire background, based on what you shared, it sounds like you can bill for the venipuncture and any labs you run in-house. The provider would only bill for the services they render, but if you are independent of them then you would bill Medicare B, or whatever insurance the patient has. I hope this helps?
I want to start a testing business. What CLIA certificates would I need
It completely depends on what tests you run and how they process specimens. Most likely, you will need a true CLIA certificate, not a CLIA Waiver. The real way to know is to research the tests you will be running to find-out the regulations of them and what is required. CLIA Certificate of Waivers are generally for easy point-of-care (POC) tests that give rapid results. Any more complex tests and processing would require a higher certificate. Good luck and thanks for watching!
What is the name of the machine
There are many different point of care tests that require a CLIA Waived Certificate. Some aren’t machines, they could use other methods to run the tests. You would have to look at each test to see if it is CLIA Waived approved or not. Thank you for watching!
I have a certificate of waiver. Can I claim without a doctor? I am a phlebotomist and have a diagnostic lab
You would have to review the practice laws in your state and if payers will reimburse you for services. I am assuming if you have a CLIA Certificate of Waiver, and are contracted with insurances, then it should be fine as long as you have orders from a doctor to perform the services on patients. I would recommend asking insurances and also the state laws for phlebotomists.