A systematic approach to billing laboratory services - The legal framework

Abstract

Reimbursement of medical laboratory services may initially seem self-explanatory to all involved - doctors, hospitals, and laboratories. However, recurrent questions on how and to whom a particular test has to be invoiced, or whether a particular mode of billing is correct, demonstrate the great complexity in this field. These and other related issues emerge if laboratory orders involve different laboratory sectors, medical tariffs, and invoice recipients. The correct invoice practice - often evident only at second glance - has fundamental legal and financial significance not just for the laboratory service provider but also for the medical client. Influencing nearly all business processes from order to invoice, the correct invoice practice deserves special attention and diligence. In this review, we cover all relevant aspects of billing medical laboratory services in the context of ambulatory care, hospital treatment, and other models on the basis of the German health care law. We focus not only on laboratory medicine and microbiology but also include human genetics and histopathology. In addition, a schematic representation of common rules of invoicing laboratory services is provided with references to the appropriate legal text sources.