Billing for Labs performed in Office

Is there a website or a book where I may get information on what guidelines are implemented for physicians who perform labs in the office?
I am confused on wether a physician can bill for a non-clia waved test that was performed in the office.
If a doctor has a CLIA #, he should be billing only for the clia-waved tests, correct?
And if he/she is billing for these clia tests, can the physician still send out the specimen to an outside lab to obtain results?

Any help is appreciated!

Billing for labs performed in the office

There are two articles in the database of Codapedia: search CLIA and they come up.

Yes, if you have a CLIA certificate and number, you can bill for lab tests. Look at the certificate and it will tell you if it is for waived tests and microscopy, or if you have a full license. Most MD offices have a license for the waived tests (which can be done by a kit) and microscopy (tests which must be read right away.)

Medicare does have a website related to CLIA

http://www.cms.hhs.gov/CLIA/

It's a little overwhelming with a lot of data, but on the left, select "categorization of tests" and then page down, and download the list of waived tests and microscopy procedures. The good thing about the list, is that it includes the specific CPT codes for the CLIA waived tests, and many specific company and brand names.

If you have more specific questions after reading the articles and looking at the CMS list, let us know.

Depends on your contract and your state law

In Illinois, pass-thru billing is allowed, and some insurers allow it, some do not. Pass-thru billing is when the doctor office draws the blood, sends the specimen to the lab and the lab sends the results to the doctor. The doctor then sends the bill for the lab processing to the insurance company and the lab sends a bill to the doctor's office for the lab processing. The risk is that the patient may not pay the doctor's bill and then you eat the cost. Depending on your rate with the insurer, if you get paid more than you pay the lab then you make money. You cannot pass-thru bill Medicare or Medicaid.