Wiki pathology billing

[elliebell]

I am needing some help with billing for pathologies. We are a dermatology practice and we send our specimens to an outside lab. This would be specimens from biopsies, excisions, etc. We are contracted with the lab and set up as what they call "client billing". The lab processes the specimen and reads the slide sending us nothing but a report as a result. The lab bills us a flat rate per specimen and we bill the insurance company for both the TC and Professional portions. Is this legal? We thought it was, however other offices state this is not legal.

Thanks for any info

 

[btadlock1]

I am needing some help with billing for pathologies. We are a dermatology practice and we send our specimens to an outside lab. This would be specimens from biopsies, excisions, etc. We are contracted with the lab and set up as what they call "client billing". The lab processes the specimen and reads the slide sending us nothing but a report as a result. The lab bills us a flat rate per specimen and we bill the insurance company for both the TC and Professional portions. Is this legal? We thought it was, however other offices state this is not legal.

Thanks for any info

You call it client billing, but payers call it "pass-through billing". I don't believe that it's illegal (at least not on the national level, or in my particular state), but the majority of payers have policies prohibiting it. They want to pay the person who did the procedure - not a middle-man.