Wiki Question regarding billing pathology charges

[lcaldwell22]

Hoping someone will be able to answer my question. We are a hospital. Our lab is a contracted service. They tell us that they are not getting paid for pathology charges to Medicaid. They are going to bill us for the services. They already bill us for pathology charges for Medicare patients. Shouldn't we bill Medicaid patients just as we do Medicare? Our biller says not to bill Medicaid. Suggestions anyone?

 

[bbell249]

You should always bill the insurance company, no matter if they pay or not. The denials are the documentation to support why you didn't get paid. If you end up having to write these charges off, you will have the documentation to back it up.

 

[moodyk13]

Hoping someone will be able to answer my question. We are a hospital. Our lab is a contracted service. They tell us that they are not getting paid for pathology charges to Medicaid. They are going to bill us for the services. They already bill us for pathology charges for Medicare patients. Shouldn't we bill Medicaid patients just as we do Medicare? Our biller says not to bill Medicaid. Suggestions anyone?

In the state of Georgia, a provider cannot bill a Medicaid patient - even if charges are denied. And Medicare patients can only be billed for denied charges if they are given an ABN before the procedures/tests/treatment occurs letting them know Medicare isn't likely to pay.

I would go to your states Medicaid website and download their claims processing manual and search it for provisions to billing pathology charges. Its very possible that the provider merely needs to apply for a PA and add that auth # on the claim, and hold the claim until approval.

For example: if we provide non-emergency ambulance transportation for a straight Medicaid patient, our billing department reviews the documentation for medical necessity. If we have the supporting documents and report from the crew members, we put the claim on hold in our system, and apply for a PA. Once we receive approval, we release the claim and submit it with the approved PA# in form field #23 ( CMS 1500 form box for prior authorizations) and we get paid.