Billing for Outsourced Labs
Our facility has a contract/agreement with a CLIA certified laboratory to provide all facility-based labs. We have an interface built so that the results interface to EPIC and we, in turn, bill the patients. We've recently been made aware of a large volume of lab denials related to missing/incomplete/invalid CLIA number. The majority of these denials are for PA Medicaid. The current claim process does not include any CLIA number and the PA MA payer specifically is requesting QW modifiers. But we are concerned, these tests are physically being performed in the CLIA certified lab that we are contracted with, not on CLIA waived devices in the facility. What is the best practice for reporting this purchased service lab scenario on the facility claim?