How do you bill for laboratory tests scheduled for next month?

Billing for Laboratory Tests Scheduled for Next Month

You cannot bill for laboratory tests that have not yet been performed—billing must occur after the service is rendered and results are available.

Core Billing Principles

Laboratory tests must be completed before billing can occur. The fundamental principle in laboratory billing is that reimbursement is tied to actual service delivery, not the scheduling or ordering of tests 1. This applies across all payment systems including Medicare, Medicaid, and commercial insurers.

Proper Billing Timeline

When to Submit Claims

• Bill only after specimen collection and test completion 1
• Results must be available before claims submission, as the date of service corresponds to when the specimen was collected and analyzed 1
• Documentation requirements include the actual performance of the test, not just the order 1

Date of Service Considerations

• The date of service is the date the specimen is collected, not when the test is ordered or scheduled 1
• For tests performed over multiple days, use the date when the final component is completed 1

Reimbursement Requirements

Documentation Standards

Complete documentation must include 1:

• Proof that the test was actually performed
• Clinical indication justifying medical necessity
• Results interpretation and reporting
• Physician order for the test

Medical Necessity

• Tests must be medically relevant for the clinical situation at the time they are performed 1
• Reimbursement compliance systems verify that testing is appropriate for the specific clinical condition 1
• "Broad-net" or anticipatory testing without specific clinical indication may not be reimbursed 1

Common Pitfalls to Avoid

Advance Billing Errors

Never submit claims for future services 1. This constitutes:

• Billing fraud if intentional
• Claim rejection if inadvertent
• Potential compliance violations with federal and state regulations

Order vs. Performance

• Simply ordering a test does not justify billing 1
• Electronic health records may generate orders, but these are not billable events until the test is performed 1
• Standing orders or scheduled tests remain unbillable until actually completed 1

Proper Workflow for Scheduled Tests

Pre-Service Phase (Current Month)

• Order the test and schedule the appointment 1
• Verify insurance coverage and obtain any required pre-authorizations 1
• Document medical necessity in the patient's record 1
• Do not generate or submit any billing claims at this stage 1

Service Phase (Next Month)

• Collect the specimen on the scheduled date 1
• Perform the laboratory analysis according to established protocols 1
• Generate and review results 1
• Document the service with date, time, and results 1

Post-Service Phase

• Submit the claim only after all above steps are completed 1
• Use the specimen collection date as the date of service 1
• Include appropriate CPT codes and diagnosis codes that reflect the clinical situation at the time of testing 1

Special Considerations

Reflex Testing

For tests that trigger additional testing based on initial results 1:

• Bill for the initial screening test when completed
• Bill for supplemental tests only after they are performed
• Do not bill for potential reflex tests that may never be needed

Quality Control

Laboratories must verify test performance before reporting patient results and billing 1. This includes:

• Calibration verification
• Control procedures
• Performance specifications confirmation