Billing Policies & Procedures

Transcription

1 Billing Policies & Procedures ANATOMIC PATHOLOGY I. INTRODUCTION UChicago MedLabs default billing policy is to bill the client for our testing services. However, as a service to our clients, UChicago MedLabs will bill your patient s medical insurance when allowable for both the technical and professional component of our testing services under the rules and requirements set forth below. In situations when we are unable to bill your patient s medical insurance, for whatever reason, we will bill the client directly for both the technical and professional component charges when both are performed. UChicago MedLabs will bill a 3 rd party payer in the following situations. Testing of original fresh tissue material taken from an outpatient for initial diagnosis 2 nd opinion consultations ordered by the patient s treating clinician UChicago MedLabs will bill a client directly in the following situations. Testing of original fresh tissue material taken from an inpatient for initial diagnosis 2 nd opinion consultations ordered by a pathologist Medicare Inpatient Exception - For Medicare Inpatients only, UChicago MedLabs will deviate from its standard billing procedure and split its laboratory service fee into two components, each billed separately. This exception applies only to laboratory services requested on behalf of inpatients with Medicare as their primary insurance. In this situation, UChicago MedLabs will bill the technical fee to the client and the professional fee to Medicare. For this exception to apply, you must alert UChicago MedLabs of its applicability and provide patient s complete Medicare insurance information at the time the specimen is submitted. Failure to comply with these requirements will result in UChicago MedLabs billing you for both fee components. II. BILLING CRITERIA AND PROCEDURES EXPLAINED A. Billing Designation Criteria The billing designation of a particular submission is determined solely by the following criteria. The type of testing ordered: original fresh tissue material for initial diagnosis vs. 2 nd opinion consultations; The type of clinician ordering the testing: the treating clinician vs. a pathologist; and The type of patient: outpatient vs. hospital inpatient. Please Note: UChicago MedLabs does not authorize exceptions on a case by case basis. 1

2 B. 3 rd Party Payer Billing 1. Testing Of Original Fresh Tissue Material Taken from an Outpatient for Initial Diagnosis UChicago MedLabs will bill a 3 rd party payer for testing of original fresh tissue material (e.g. biopsy specimens) from your outpatient, provided that, all patient medical insurance information is supplied at the time of specimen submission and the requisition form is clearly marked to direct patient billing because of the type of submission. Please Note: Complete patient medical insurance information includes any of the following documents necessary for your patient s insurance to cover laboratory testing services at the University of Chicago Medicine: Referrals for lab services Prior Authorizations for lab services Pre-Approval Forms for lab services For services deemed covered by your patient s medical insurance, any charges not paid by your patient s medical insurance, such as deductible amounts or copayments, will be billed to your patient directly. When your patient s medical insurance denies coverage for our laboratory testing services, for any reason, all charges will be billed to the client directly. UChicago MedLabs will bill the client directly for all charges associated with laboratory testing on your uninsured patients specimens unless the client makes arrangements in advance nd Opinion Consultations Ordered by the Patient s Clinician UChicago MedLabs understands that the nature of clinical and anatomic pathology dictates that in some instances, previously tested slides or other material will be forwarded to UChicago MedLabs at the request of someone outside of the client s pathology department. In these cases, the client s pathology department is merely forwarding the material at the request of the patient s ordering clinician. When this occurs, UChicago MedLabs will bill the patient s insurance rather than the client, provided that, all patient medical insurance information, the ordering clinician s name and NPI are supplied at the time of specimen submission and the requisition form is clearly marked to direct patient billing because of the type of submission. If you comply with these requirements we will not bill you but will bill the patient directly. For 2 nd opinion consultations ordered by the patient s clinician, UChicago MedLabs will provide a report of the results to the ordering clinician as specified on the requisition form. UChicago MedLabs will also send a courtesy report to the pathology laboratory that submitted material on behalf of the ordering clinician. All results will be reported by fax. 2

3 3. Medicare has announced a change to its reimbursement procedures which will require all ordering and referring providers to be enrolled in the PECOS system as a condition of payment. Although you may already be enrolled in the PECOS system and therefore in compliance with the new rule, UChicago MedLabs is alerting you that we will be required to bill you directly for any Medicare payment denials caused by your failure to comply with the PECOS enrollment requirement. 4. Please be advised that failure to submit complete and accurate patient medical insurance billing information at the time specimen is submitted may result in the client being billed for all services. C. Billing Information to Share with Your Patients Please inform your patients that they will receive two statements for UChicago MedLabs testing services; one from The University of Chicago Medicine and one from The University of Chicago Physicians Group. Either statement may contain a bill for charges associated with UChicago MedLabs laboratory testing services. Charges for services deemed covered by your patient s medical insurance, but not paid, such as deductible amounts or co-payments are your patient s responsibility and must be paid in full. D. Client Billing 1. Testing Of Original Fresh Tissue Material Taken from an Inpatient for Initial Diagnosis When testing of original material is ordered on behalf of a hospital inpatient, UChicago MedLabs will bill the client both a technical and professional component (when both are performed) for all services rendered. Requests on behalf of inpatients will be billed to the client regardless of who orders the tests nd Opinion Consultations Ordered by a Pathologist When UChicago MedLabs receives a 2 nd opinion consultation ordered by a pathologist in either a hospital or independent lab, UChicago MedLabs will bill the client both a technical and professional component (when both are performed) for all services rendered. 3

4 3. Rationale for Client Billing In order to remain compliant with current government rules and regulations, UChicago MedLabs must bill and receive payment for our services. Accordingly, we will always client bill for testing of original fresh tissue material ordered on behalf of a hospital inpatient. Likewise, we will always client bill for 2 nd opinion consultations ordered by a pathologist. It is UChicago MedLabs understanding and experience that our efforts to collect payment from 3 rd party payers for these types of services will be denied because our services are considered part of the referring institution s care for which it has already submitted a claim. 4. Billing Procedures When client billing is deemed appropriate, UChicago MedLabs will send the client an itemized invoice indicating the date of service, patient name, CPT code, test description, charge code, and charges. The test charge will include both a technical and professional component (when both are performed). UChicago MedLabs will not bill the patient s insurance separately for professional component charges. The only exception is for hospital in-patients with Medicare as their primary insurance (see Medicare Inpatient Exception, above). Test charges are generated once all services that were initially ordered are completed. Invoices for the past month s charges are created and mailed at the end of the current month and are payable 30 days after the invoice date. Requests for additional testing will be billed separately at a later date following the same billing cycle. Please be advised that testing completion times can vary depending on the nature and complexity of the test. The client must submit any claim disputes in writing to UChicago MedLabs within 20 days of the invoice date. This includes disputes where UChicago MedLabs billed the client rather than your patient s insurance. UChicago MedLabs will not accept a claim dispute beyond this period. 5. Billing Cycle Examples You submit a biopsy specimen to UChicago MedLabs on June 28, 2015 for testing. Testing is completed on July 05, 2015 and a charge is generated for the services on that day. An invoice dated August 30, 2015 will be sent to you for the services. Payment is expected no later than September 30, You order additional testing on the same biopsy specimen on August 1, Testing is completed on August 10, 2015 and a charge is generated for the services on that day. An invoice dated September 30, 2015 will be sent to you for the additional services completed on August 10, Payment is expected for the additional services no later than October 30, AT THE FOREFRONT O F PATHOLOGY & LABORATORY DIAGNOSTICS

5 III. ADDITIONAL INFORMATION CPT Codes. It is your responsibility to determine correct CPT codes to use for your own billing. While UChicago MedLabs may use CPT codes in the UChicago MedLabs Test Catalog, as part of invoicing, or in other written materials, this use only reflects UChicago MedLabs interpretation of CPT coding requirements. UCHICAGO MEDLABS ASSUMES NO RESPONSIBILITY FOR BILLING ERRORS DUE TO YOUR RELIANCE ON CPT CODES LISTED OR USED BY UCHICAGO MEDLABS. The billing policies and procedures of UChicago MedLabs are independent and distinct from the relationship between you and your patients. As such, how you bill your patient or whether you are reimbursed by your patient does not affect or alter UChicago MedLabs policies. Your submission of specimens for testing will be considered acceptance of UChicago MedLabs billing policies and procedures and an agreement to pay for all services rendered. The above policies and procedures are based on UC hicago MedLabs ongoing efforts to provide efficient and high quality laboratory services while maintaining compliance with applicable laws and regulations. Any exception to the above procedures for individual patients must be approved in writing by the University of Chicago Medicine prior to specimen testing. For questions regarding UChicago MedLabs billing policy please contact: Lisa Jo Abbo, Assistant Director of UChicago MedLabs at AT THE FOREFRONT O F PATHOLOGY & LABORATORY DIAGNOSTICS