Description:
The Omnibus Budget Reconciliation Act of 1990 further clarifies the mandatory assignment provision which applies to laboratory services performed in a physician's office. Assigned claims for clinical laboratory services are reimbursed at 100 percent of the approved amount with no coinsurance or deductible applied.

Policy Statement:
Physicians must accept assignment for clinical diagnostic laboratory services performed by the physician or under their supervision. Medicare will deny any clinical laboratory charges filed by a nonparticipating physician on a non-assigned claim as non-covered.

Nonparticipating physicians who render a clinical lab service and other office services on the same day may file two separate claims--one accepting assignment for the clinical lab service and another non-assigned claim for other services. This is the only instance where Medicare accepts two different assignment intentions for the same date of service.

As assigned laboratory claims are reimbursed at 100 percent of the approved amount, there is no coordinated payment. These charges should be submitted with a provider remittance and should be non-covered as paid in full by Medicare.

When claims are submitted for coordination they should always have an Explanation of Medicare Benefits or Provider Remittance attached. If either of these is missing, charges should be non-covered for lack of Medicare information.