Wiki Provider Signature

[quizon.marie12@gmail.com]

Hi I need clarification when it comes to physician signature when ordering laboratory testing. Do we need the actual signature from the doctor or electronically signed showing the provider's name including their credentials will be sufficient?

Also, when it comes to Toxicology if the Laboratory performing the test is OON from HMO insurance is there a way for their claims to get paid? I've been working in a laboratory for more than a decade doing billing and whenever we try to outsource because of the volume of work the prospect company is informing us that even we are OON lab we will be able to get reimbursed for toxicology testing and I am curious if this is correct or they're just saying it to get the business. I know correct coding is one of the factors that helped for reimbursement but other than this, I am not aware of any method that we will be reimbursed for this testing especially HMO insurances who have specific guidelines in reimbursement.

Any help will be very much appreciated.

Thank You

 

[danachock]

Hello quizon.marie12@gmail.com,
May I ask a question please? What do you believe is the difference between an actual signature (possibly a scanned in "order" document) versus an electronic signature?
Those requirements for our clinicians to log in and provide an electronic signature (those necessary passwords, and dual authentication) mean the same thing as a paper document that needs to be scanned in for a laboratory order in my opinion. The laboratory order, pathology report, any type of amendment or addendum, surgical procedure, E&M visit, anesthesia record, and so on should fall in this rationale.
If insurance requires a copy of any of the things I just stated, and it was electronically signed there shouldn't be an issue.

Next discussing toxicology for the laboratory performing tests on a patient that is OON (out of network); please be kind and do not use acronyms (not everyone has all of those memorized yet).
I don't have the privilege to review or work your denials. But I will tell you as one that has worked denials for many years one of two things are happening here.
1) Since patient was OON (out of network); they seriously NRP which means "next responsible party" everything to the patient to pay out of their pocket at full price (no insurance discounts).
2) Or again, because the patient was OON (out of network); felt that the charges didn't meet medical necessity among a HUGE other pile of other denial reasons, and they are now repeatedly denying those charges and your facility doesn't receive anything unfortunately.
3) Another option, your HMO was accurate and paid the claim. But again, I clearly don't know.
Be vigilant and reach out to your internal colleagues at your facility (Billing Team, Revenue Cycle, Revenue Integrity, Billing Rejections Analysts, and your Denial Team).
Ask them if those toxicology claims (from your original statement) are being properly reimbursed.
Be vigilant, you posed a fantastic question and I'm hopeful I provided some assistance.
Dana