XIII. Clinical Laboratories


Question 1: What situations do the surcharges not apply to revenue received for clinical laboratory services rendered by a designated provider of services?



Question 1: What situations do the surcharges not apply to revenue received for clinical laboratory services rendered by a designated provider of services?

Answer 1: The surcharge obligations established under Public Health Law Section 2807-j are applicable to revenue received for patient services related to a preadmission, inpatient, outpatient, or post-discharge visit, including all items or services as are necessary for such care, except where excluded in §2807-j. Examples of revenues which fall outside this definition include: (revenue received for "referred" lab services (discussed below), revenue received for clinical laboratory tests performed in connection with the screening of employees for drug use, revenue received for clinical laboratory tests and/or physical examinations performed in connection with applications for life insurance, health insurance, disability insurance or employment, revenue received for clinical laboratory tests performed for the purpose of establishing paternity, revenue received for forensic laboratory testing, revenue received from sponsoring agencies for clinical laboratory tests performed in accordance with approved research protocols for the primary purpose of medical research, revenue received for clinical laboratory tests performed in accordance with OHSA requirements. In each of these instances, exemption status is allowed since related diagnostic procedures are not primarily or directly linked to the potential for an admission as an inpatient, or an outpatient for treatment. Additionally, revenue received for veterinary laboratory testing falls outside the definition of net patient services revenue since such procedures are not primarily or directly linked to the potential for human treatment.

Please note, effective for dates of service claims October 1, 2000, and forward, "referred" laboratory services are no longer subject to a HCRA surcharge.

For general hospitals, referred (ordered) ambulatory care laboratory services are defined as clinical laboratory services provided to non-registered patients upon the order and referral of a qualified physician, physician´s assistant, dentist, or podiatrist to test or diagnose a specimen taken from a patient. For purposes of the specific service being ordered for a specific patient, the physician ordering the service may not be employed by or under contract to provide direct patient care for the hospital, and including any extension clinics operated by the hospital.

For diagnostic and treatment centers (D&TC), referred (ordered) ambulatory care laboratory services are defined as clinical laboratory services provided to non-registered patients of the D&TC (i.e., persons who are not registered with the comprehensive diagnostic and treatment center or ambulatory surgery center as patients for purposes of the specific clinical services being ordered) upon the order and referral of a qualified physician, physician´s assistant, dentist, or podiatrist to test or diagnose a specimen taken from a patient. For purposes of the specific service being ordered for a specific patient, the physician ordering the service may not be employed by or under contract to provide direct patient care for the D&TC.

It should be noted that "pre-admission" clinical laboratory testing ordered due to impending ambulatory surgery or inpatient or outpatient treatment and performed by the licensed hospital or D&TC providing such treatment, is not considered referred ambulatory laboratory testing because it is a service delivered in direct conjunction with a surchargeable service. Consequently, revenue associated with such laboratory testing is not excludable revenue and is subject to a surcharge.

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