Q&A: Lab date of service policy and Medicare Advantage

Q: Does this new policy apply to traditional Medicare only or does it also apply to Medicare Advantage?

A: This policy applies to both Medicare and Medicare Advantage. It’s partly a payment policy but it’s also a coverage policy because of the overarching prohibition of unbundling. Most Medicare Advantage contracts pay a percentage of Medicare. So if Medicare is going to pay separately, then they're going to want it billed in that same way so that they can get paid under the Medicaid Advantage plan. If it’s a non-contracted Medicare Advantage plan, then you will follow fee-for-service billing.

This question was answered by Valerie Rinkle, MPA, CHRI, during the March 18 webinar New Lab Date of Service Billing Requirements: Strategies for Success.