[Histonet] Billing on Send-out Consultations

[Weems, Joyce]

This has become a real problem in that many consultants will only bill the facility. The best consultants have stopped billing the patient's insurance. We cannot bill professional charges because our pathologists are contract physicians. We go round and round all the time, and usually the hospital ends up absorbing charges. 

I'm anxious to know how others are handling it. It is my understanding that if a clinician orders a second opinion, the patient's insurance will pay. However, this has to be precertified and all that jazz before this will happen. I have a wonderful lab assistant who works very hard to keep it all together, but we still have to absorb lots of charges. Some of the insurance companies have a hard time understanding that the patient is not going for referral, but that the patient's pathology case is going. It's a very frustrating endeavor that I hope will become more black and white instead of such a gray area. Pathology has so many gray areas in billing.  

Joyce

Joyce Weems
Pathology Manager
Saint Joseph's Hospital of Atlanta
404-851-7376
404-851-7831 - fax

-----Original Message-----
From: histonet-bounces <@t> lists.utsouthwestern.edu [mailto:histonet-bounces <@t> lists.utsouthwestern.edu]On Behalf Of Nita Searcy
Sent: Monday, February 13, 2006 7:53 AM
To: histonet <@t> lists.utsouthwestern.edu
Subject: [Histonet] Billing on Send-out Consultations

Can someone give me some references regarding the above? (Consultations
sent to other pathologists for second opinion/ verification).

I know that the "receiving "entity bills  codes 88321; 88323; or 88325.


How does the sending lab bill patient? Can they?  I have a pathologist
that insists there must be a mechanism for billing these. I have
received  conflicting answers. I need a document- reference  that
verifies whatever is the rule.

Thanks

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