Did you know that Medicare rules can change your billing? See if they affect you.
Foundation Medicine is committed to doing things the right way in all facets of its business—by providing quality testing for patients, by offering timely and reliable customer service, and by billing for its services responsibly and correctly. Compliance with Medicare rules and regulations is critical to achieving this goal.
One of the more complex Medicare billing rules with which Foundation Medicine, and its customers, must comply, is the so-called 14-day rule. The 14-day rule helps to establish who will be billed for a test provided to a Medicare patient. In some cases, Medicare is billed directly for Foundation Medicine testing. In other cases, the 14-day rule requires that Foundation Medicine bill its hospital customers for testing that is performed on Medicare patients.
The 14-Day Rule
About the Medicare Date of Service Rule
What Is It?
The “Date of Service rule” under applicable Medicare rules determines whether or not the clinical laboratory service, is bundled into either (i) the diagnosis-related group (DRG) payment made to the hospital for in-patients or (ii) paid separately under the Outpatient Prospective Payment System (OPPS). In general, the date of service is the date the specimen was collected.
Who Is Affected
|Type of Patient||Registered?||Our Billing Practice|
Patient admitted overnight in a hospital
|Yes||Foundation Medicine bills Hospital (included in the DRG).
However, if the test is ordered more than 14 days post discharge, Foundation Medicine will bill Medicare.
Patient admitted and discharged before the end of the day
|Yes||Foundation Medicine bills Hospital. The Hospital will bill clinical CPT codes to Medicare on CLFS.
However, if the test is ordered 14 days post discharge, Foundation Medicine will bill Medicare.
Patient is neither “In” nor “Out” patient
|No||Foundation Medicine bills Medicare.|
What is the Medicare 14-day rule?
The Medicare 14-day rule determines what date Medicare will consider to be the date of service for purposes of establishing who may bill Medicare for certain laboratory services (e.g., the date a specimen was collected, the date a patient was discharged, or the dates specimen was retrieved from storage).
To whom does the rule apply?
The rule impacts those who collect specimens for clinical laboratory testing, order clinical laboratory tests or perform clinical laboratory services.
How does the 14-day rule impact my relationship with Foundation Medicine?
The 14-day rule determines whether Foundation Medicine will bill Medicare or bill the hospital for a test it provides to a Medicare patient.
Who will receive a bill for a Foundation Medicine test if it is ordered less than 14 days after an inpatient or outpatient is discharged?
If a physician submits an order less than 14 days after an inpatient or outpatient is discharged, Foundation Medicine will bill the hospital for performing the test.
What if I have to cancel a test?
Canceling a test is not a problem as long as the decision to do so is guided by appropriate clinical judgment and not to avoid the application of Medicare billing rules. Foundation Medicine will follow applicable billing rules based on the date you order a test. Foundation Medicine takes no position as to what the best clinical timing may be for any specific patient.