The Missouri Medicaid Audit and Compliance Unit (MMAC) is providing the following reminders for physicians and laboratories that are enrolled in MO HealthNet and for hospitals that bill for non-enrolled laboratory services.
The MO HealthNet provider manual for physicians sets forth the following requirements:
- An outside laboratory performing outpatient laboratory services must bill MO HealthNet for the services when the laboratory is an enrolled MO HealthNet provider. A hospital may bill MO HealthNet for outpatient laboratory services performed by a non-MO HealthNet enrolled outside laboratory.
- Physician offices may bill for initial drug screens performed at point of care, and hospital laboratories may bill for screenings they performed, but both cannot be billed. It shall be the responsibility of the ordering physician to coordinate with the performing laboratory for the billing of drug screen tests.
- Providers should not routinely bill for the quantification of drug classes. Providers should only bill for the quantification of a drug class or a confirmatory drug test if there is a positive screen for the drug class to be quantified. Quantification or confirmatory drug tests for a specific substance may be ordered if medically necessary. Documentation of medical necessity must be recorded in the patient medical record.