Billing and medical necessity

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The page below is a sample from the LabCE course Medicare Compliance for Clinical Laboratories (retired). Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Billing and medical necessity

  • Billing:
    • Highest risk activity a laboratory has. All laboratory activities contribute to the billing process.
    • Many of the risk areas included in this program are components of the billing function.
  • Medical necessity:
    • Medicare is only allowed, by law, to pay for tests that are reasonable and necessary for the diagnosis and treatment of disease.
    • Medical necessity is an underlying principle of the Medicare program.
    • Tests performed for screening or routine exams are not considered medically necessary by the Medicare program.