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Industry Insights

UHC announces limitation for non-patient lab reimbursements

UnitedHealthcare has announced it will begin limiting reimbursements for hospitals acting as reference labs or conducting diagnostic testing on non-patients, according to a recent bulletin issued to providers.

According to the notice, for claims paid on or after May 1, 2020, “hospitals acting as a reference lab or conducting diagnostic testing for non-patients cannot bill for such non-patient diagnostic laboratory tests under that hospital’s Facility Participation Agreement. Hospitals wishing to participate in UnitedHealthcare‘s commercial network as a Reference Laboratory may apply with UnitedHealthcare to be credentialed and contracted as a Reference Laboratory.”

The notice provides the following definitions for reference labs and non-patients:

• Reference Laboratory: A laboratory that performs diagnostic testing on specimens it receives from other referring laboratories or care providers.

• Non-patient: Is a member that is neither an inpatient nor an outpatient of a hospital, but for whom a specimen is submitted for laboratory testing to a hospital.

If you would like assistance beginning the credentialing and contract process for your hospital to become a UHC reference lab, feel free to reach out to us at 517-486-4262 for assistance.

In the interim, claims submitted for non-patient diagnostic laboratory tests, or claims where a hospital is acting as a Reference Laboratory, will be denied for failure to comply with this protocol in the event a hospital is billing under its Facility Participation Agreement.

Interested in learning more about coding audits or improving your overall revenue cycle management? Contact us today for a free consultation.

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