Crossmatch Billing

[MHiggins]

Question: Do you bill for all crossmatches performed? Or only the ones that were ordered?

Example: 1 RBC is ordered. Patient has a an antibody. You grab 4 units and crossmatch through Coombs. You then antigen type the compatible units. Do you bill for four XMs? Or just one? What about antigen typing? Four units? Or just one?

 

We used to bill for all work done. Then someone told my director that we could only bill for what was ordered or it was medicare fraud.... but, I feel like that is not applicable to patients with antibodies that require much more work to find compatible blood.

Thanks,

Morgan

[MaryPDX]

We bill for all crossmatches performed.

[mollyredone]

We don't usually crossmatch before antigen typing, but we charge for every antigen typing, positive or negative.  Use judgment-don't antigen type 10 units to find one K-negative unit.  We also charge if there are multiple antibodies-3 antibodies, 2 units is 6 antigen typing charges (at least).

[AMcCord]

I charge for only the # of crossmatches ordered, but I do charge for as many antigen types as necessary to come up with the number of units I need to crossmatch. I follow the same game plan as mollyredone.

[NicolePCanada]

I'm so glad I live in Canada. We don't bill for anything, we just do it.

[Malcolm Needs ☆]

Ditto me in the UK.

[SMILLER]

As a side question (for you 21st century socialized medicine folks):  you may not have to bill for each task, but do you not have to keep track of work-load data for your lab?

Scott

[Malcolm Needs ☆]

9 minutes ago, SMILLER said:

As a side question (for you 21st century socialized medicine folks):  you may not have to bill for each task, but do you not have to keep track of work-load data for your lab?

Scott

Oh God do we!!!!!!!!!!!!!!!!!

[SMILLER]

19 hours ago, MHiggins said:

Question: Do you bill for all crossmatches performed? Or only the ones that were ordered?

Example: 1 RBC is ordered. Patient has a an antibody. You grab 4 units and crossmatch through Coombs. You then antigen type the compatible units. Do you bill for four XMs? Or just one? What about antigen typing? Four units? Or just one?

 

We used to bill for all work done. Then someone told my director that we could only bill for what was ordered or it was medicare fraud.... but, I feel like that is not applicable to patients with antibodies that require much more work to find compatible blood.

Thanks,

Morgan

Its a bit unusual to cross a unit before antigen typing it, but it is necessary in some cases to conserve antisera or whatnot.  Anyway, in the above example, we would bill for one xmatch and 4 antigen typings. 

And having said that, if you have an approved policy stating that the work you are doing is required to take care of the original order, I would think that you could bill for all of it.

(At our facility, we would check the patient's status and likely order (and bill) for two more crossmatches as well per our policy for atypical antibody patients.)

Scott

[MHiggins]

30 minutes ago, SMILLER said:

As a side question (for you 21st century socialized medicine folks):  you may not have to bill for each task, but do you not have to keep track of work-load data for your lab?

Scott

I'm unsure of what you are asking exactly? We do keep all testing records on file.

[MHiggins]

13 minutes ago, SMILLER said:

Its a bit unusual to cross a unit before antigen typing it, but it is necessary in some cases to conserve antisera or whatnot.  Anyway, in the above example, we would bill for one xmatch and 4 antigen typings. 

And having said that, if you have an approved policy stating that the work you are doing is required to take care of the original order, I would think that you could bill for all of it.

(At our facility, we would check the patient's status and likely order (and bill) for two more crossmatches as well per our policy for atypical antibody patients.)

Scott

It is regular practice in our area (multiple facilities follow this process) to crossmatch before antigen typing when time allows in order to conserve expensive antisera. Crossmatches are cheap in comparison to some antisera. However, we would antigen type initially or at the same time as we crossmatch in a stat situation or when the patient has a negative antibody screen.

[SMILLER]

That seems reasonable, as long as it is documented as policy, I do not see why you could not bill for all that.

Scott

[exlimey]

20 minutes ago, MHiggins said:

I'm unsure of what you are asking exactly? We do keep all testing records on file.

I think Scott is saying that there is still a cost associated with each test, regardless of billing. Socialized medicine bean-counters have a very real interest in making things efficient and cost effective. Redundant or unnecessary testing is the target in such situations.

Edited January 9, 2018 by exlimey
typo

[MHiggins]

1 minute ago, exlimey said:

I think Scott is saying that there is still a cost associated with each test, regardless of billing. Socialized medicine bean-counters have a very real interest in making things efficient and cost effective. Redundant or unnecessary testing is target in such situations.

Ah. Well, they don't track the blood bank workload like they do the rest of the lab so it currently is a non-issue. 

[TreeMoss]

We listened to an ARC sponsored reimbursement webinar a few years ago where we were told that we could charge for all crossmatches and antigen typings performed, within reason.  We will also crossmatch first and then antigen type the compatible units if the antibody is showing -- to conserve that expensive antisera.

[John C. Staley]

This is a very interesting discussion and one that could bite you depending on who is asking questions.  A number of years ago I was called down to the billing department to have a chat with an insurance person reviewing the billing for a patient.  The patient had had a TURP performed and as was the norm back then the doctor had ordered and we had crossmatched 6 units of blood.  As luck would have it the patient did not us a drop of blood, one of the fortunate few.  The insurance person was going to deny payment for the crossmatches on the grounds that they were unnecessary.  Initially I tried to very calmly explain that this was a common order for this procedure and in most cases the patient used some of the blood if not all and this case was unusual in the sense that they had not been transfused.  The insurance person could not let go of the fact that the crossmatches were unnecessary expenses because the patient obviously didn't need them.   I finally gave up and told the insurance person that it was a very sad day when insurance companies began practicing medicine.  I was able to escape the room just before her head exploded!  I never did follow up to see if we were paid for those crossmatches or not. 

Bottom line for me is, if they question testing that was ordered do not be surprised when they question testing that was not specifically ordered regardless of how much sense it makes to us.  The antigen testing is easy to defend, the additional crossmatches, not so much.  We would screen units by crossmatching but not charge for them until additional units were ordered.  This is a little more difficult to achieve in the computer environment.

Edited January 10, 2018 by John C. Staley

[exlimey]

20 hours ago, John C. Staley said:

This is a very interesting discussion and one that could bite you depending on who is asking questions.  A number of years ago I was called down to the billing department to have a chat with an insurance person reviewing the billing for a patient.  The patient had had a TURP performed and as was the norm back then the doctor had ordered and we had crossmatched 6 units of blood.  As luck would have it the patient did not us a drop of blood, one of the fortunate few.  The insurance person was going to deny payment for the crossmatches on the grounds that they were unnecessary.  Initially I tried to very calmly explain that this was a common order for this procedure and in most cases the patient used some of the blood if not all and this case was unusual in the sense that they had not been transfused.  The insurance person could not let go of the fact that the crossmatches were unnecessary expenses because the patient obviously didn't need them.   I finally gave up and told the insurance person that it was a very sad day when insurance companies began practicing medicine.  I was able to escape the room just before her head exploded!  I never did follow up to see if we were paid for those crossmatches or not. 

Bottom line for me is, if they question testing that was ordered do not be surprised when they question testing that was not specifically ordered regardless of how much sense it makes to us.  The antigen testing is easy to defend, the additional crossmatches, not so much.  We would screen units by crossmatching but not charge for them until additional units were ordered.  This is a little more difficult to achieve in the computer environment.

Well said, John.

We've all been in positions where "extra work" was logical because either the original request was wonky or we did it for our own sanity.

[AMcCord]

On 1/9/2018 at 10:23 AM, MHiggins said:

It is regular practice in our area (multiple facilities follow this process) to crossmatch before antigen typing when time allows in order to conserve expensive antisera. Crossmatches are cheap in comparison to some antisera. However, we would antigen type initially or at the same time as we crossmatch in a stat situation or when the patient has a negative antibody screen.

Screening with antisera is 86903. You used to be able to charge 86904 for antigen screening using patient plasma, in other words, by crossmatching. I'm not sure whether that is still chargeable or not. I teeny brain is telling me that it is no longer valid, but I could be wrong.