Lab Order Billing Compliance
In accordance with Xeron’s company culture of integrity and professionalism, we follow all New York state, and federal laws governing the clinical laboratory. Laboratory orders are considered an official request by a physician or credentialed clinician for a patient to have laboratory testing. A requisition is considered a legal document reflecting the laboratory orders and upon compliance also grants permission to the laboratory to bill the patients’ insurance.
CMS (Center for Medicare and Medicaid Services) is the governing body who creates, revises, and enforces compliancy guidelines for laboratory orders and requisitions. Insurance carriers require compliant orders before payment is made. Periodic audits of laboratory documentation can be initiated by CMS and by independent insurance carriers at any time. Each audit requires the laboratory to produce a copy of the original laboratory order and/or test requisition. For CMS documentation requirements for laboratory services click here.
- Xeron ICD-10 Codes (commonly used)
- Xeron ICD-10 Behavioral Health Codes (commonly used)
- Xeron ICD-10 Codes (problematic tests)
- Xeron Non-covered ICD-10) Codes for All Lab NCD’s
CMS Law Updates
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R 131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service – FFS) beneficiaries in situations where Medicare payment is expected to be denied. The ABN is issued to transfer potential financial liability to the Medicate beneficiary in certain instances.
The list below outlines what is required on a compliant order or requisition. For questions, we are happy to assist. 866-937-6652
Requirements for a compliant lab order:
- Patients full legal name
- Patients DOB
- Patients last 4 of SS# (not required but helpful)
- Ordering Physician & NPI #
- Ordering Physicians signature
- Valid ICD-10 diagnosis code.
- Patients insurance (if applicable)
Billing for Patients
XCL’s live, experienced, in-house billing representatives are available to assist. The billing department supports all compliance guidelines when submitting claim(s) to your insurance. Our billing team will make every attempt to bill your insurance carrier, when applicable.
Upon processing, your insurance company will send you an ‘Explanation of Benefits’ for your records. This is only an explanation of services charged to your insurance carrier. THIS IS NOT A BILL
Reasons you may receive a bill from Xeron:
- Your insurance coverage is capitated to another laboratory
- You have outstanding deductibles and co-payments with your insurance carrier
- The test ordered is not covered by your insurance carrier
- The test ordered does not meet limited coverage or medical necessity guidelines.
If you receive a bill from us and have questions, we are here to assist. For better service, please have your insurance information, your explanation of benefits, and your bill available when you call. Payment plans are available for qualifying balances.
To ensure accuracy, if you do not see your insurance listed, or are unsure of your insurance coverage, contact a Xeron Billing Representative at 866-937-6652 for more information.
Insurance Plans Accepted