Primary Care Coding Alert

Question: Our physician has been running some very specific tests (saliva, stool, heavy toxic element screening, 90 panel allergen, etc.). We bill the patient's insurance, and then the lab bills us. We also ask the patient to sign an ABN in case the test isn't covered. Some of the insurers aren't paying what my physician is being billed. Can we bill the patient for the remainder when the insurer pays very little toward our cost?

North Carolina Subscriber

Answer: Not likely; you cannot bill the patient for the remainder if you're contracted with the insurance company. You must write off any amount not covered due to the insurer's fee schedule. It might be time to negotiate a new contract with the lab or to handle things differently. For instance, let the lab bill out the tests to the insurer, and your physician can bill the lab handling.