Newsletter Vol. 3, No. 40

Immediately: Billing team must audit all laboratory test billing workflows for New Jersey Medicaid claims. (1) Identify any instances where the practice bills for lab tests that were actually performed by a reference laboratory—these claims must be stopped and rebilled to the reference lab or denied. (2) Ensure that only the performing CLIA-certified laboratory bills for the test itself (e.g., Pap smear, blood work). (3) Update billing system and encounter forms to enforce that originating/collecting providers bill ONLY for venipuncture (specimen collection) using appropriate CPT codes, not for the lab test interpretation/performance. (4) Train providers and front-desk staff on the distinction: collecting the specimen ≠ performing the test. (5) Review any standing orders or contracts with reference laboratories to confirm reference labs are billing for their performed tests, not the originating practice. Failure to comply will result in claim denials and potential program exclusion per CLIA requirements.