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Charging for a reference lab fee

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Most of the patients we see that need reference work are Medicare patients. The money pot for their admit diagnosis is the same size no matter what is ordered or charged so my director sees no point in doing more than charging for the testing we've done and charging exactly what reference has charged us. I charge the extras manually.

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My boss is telling me that I can't charge for a reference lab fee.  I can't charge for anything that we both did.  If I perfomed a Type and screen and a DAT and so did the ref lab I can't charge for that.  He said it's basically a loss. 

 

 

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That's how it is for us.

We did a DAT, so does reference - we charge for one.

We also were told we can't pass on STAT fees or other miscellaneous charges. We did finally manage to build a rare unit fee, since we get charged so much for that on occasion.

Make sure you are charging for everything they do, at least as much as possible -- we commonly pass on a charge for elutions, adsorptions, chemical treatment of RBCs, red cell separation and molecular typing.

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We charge for everything done and have separate 'billing codes' that identify which are in-house vs which are reference laboratory. We were also told we can't pass on STAT/import fees, only things related to patient or donor unit testing/processing.

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Ask your blood supplier if they can give you a list of their charges with CPT codes attached. If there is a CPT code, you can charge for it. If there isn't, you eat it. The STAT, call in, import fees, etc. are the ones with no CPT codes. I bill much like Teristella. If I do it, I bill for it. If reference does it, I only bill for it if it doesn't duplicate my charge. Exceptions might be antibody screen and antibody ID - those can be billed separately for each method used. My panels and screens are usually done with solid phase. Reference uses tube, sometimes gel. Those additional screens and panels can then be charged as different media. For ID panels, you can charge for each panel AND media.

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We got a list of CPT codes and charges from our reference lab.  We bill them as "Bill only", which means there is no work shown in our computer.  So we charge for additional antibody IDs or DATs as BO DAT and BO ABID ADD.  We also charge for patient and unit antigen typing as BO AG PT or BO AG UNIT.  I haven't heard from anyone that these are not valid charges, but maybe they just don't pay them.  Still, if you don't charge for your work, CMS reimbursement will never change!

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We also get a list of CPTs from the reference lab and pass them on to fiscal. But as AMcCord points out, whether your hospital gets paid for them or not is another matter entirely.

Edited by Dr. Pepper

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On 2/10/2016 at 1:08 PM, goodchild said:

We charge for everything done and have separate 'billing codes' that identify which are in-house vs which are reference laboratory. We were also told we can't pass on STAT/import fees, only things related to patient or donor unit testing/processing.

This is how we do it (as bill only tests).  If it got done, then it gets billed.  Occasionally reimbursement will call me and question charges but I have the charge sheets from our IRL to show that the charges are appropriate.  The insurance company pays us whatever they want to, but I submit the charges regardless of reimbursement.  

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Anyone do this through Paragon?   I'm new to this system.  I assume if I try to charge with a CPT code.  We'd have to have that code built in our system, yeah?

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We are currently using Paragon (though not for much longer :clap:) and I bill those extra reference charges manually with a CPT code. It's done in Patient Management under Daily Processing...Activity Posting. I was given access to that one function for billing purposes. It is not difficult to use. Our techs responsible for sendouts and I bill anything that isn't built into the system that way. If it isn't something that is sent out fairly frequently, it doesn't get built. If you can get your business folks to built those tests for you - BONUS!

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6 hours ago, AMcCord said:

We are currently using Paragon (though not for much longer :clap:) and I bill those extra reference charges manually with a CPT code. It's done in Patient Management under Daily Processing...Activity Posting. I was given access to that one function for billing purposes. It is not difficult to use. Our techs responsible for sendouts and I bill anything that isn't built into the system that way. If it isn't something that is sent out fairly frequently, it doesn't get built. If you can get your business folks to built those tests for you - BONUS!

Oh great!  I already have access to Activity Posting and have used it to bill for other things in blood bank.  Hope I can try it out soon. We sent a patient out last Friday to the ref lab.

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