Your Quick Guide to Understanding the Weird 14 Day Rule (CMS Billing for Lab Tests)

Note: There have been several updates after this 2015 blog, most notably, a 2018 rule, implemented in 1/2020, that outpatient genomic tests are billed by the lab that performs them (be it the originating hospital lab or the reference lab).  See ongoing updates at CMS home page for 14-day-rule:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Clinical-Lab-DOS-Policy#:~:text=In%20general%2C%20the%20date%20of,patient's%20discharge%20from%20the%20hospital.

ORIGINAL BLOG 2015

Babe Ruth marveled that he got "paid for playing baseball," since it was so much fun.  I marvel that I get paid for explaining Medicare's lab test "14 day rule" - because it is so bizarre.

For some examples of how unpopular this rule is in policy circles, see here.   More after the break.