We utilize electronic crossmatch whenever possible and our billing department is rejecting the charge for outpatients if the date of service is not the same date as the sample collect date. We have the billing capture point for our tests set to be the date the sample is collected but we do not have a way to do this for the ELXM charge. I can set the billing date to be the sample collect date for IS and AHG crossmatches but I do not want to perform IS crossmatches on outpatients just to get the correct date of service on the charge.

Is anyone else having this problem?

Root cause: Why does your billing dept reject these? It would be possible for crossmatches in other situations to be done on a day different from the specimen draw-date. For example: Special screened units that took awhile to find or order in.

I'm curious why outpatient samples are not being crossmatched on the day of draw. While we occasionally have outpatients drawn one day and transfused the next, we always crossamatch them when we do the T&S, just to get the paperwork ready to go.

Outpatient accounts are generally active for one calander day only. If a particular class of patients is causing problems, you could set them up as on recurring account, like we do our dialysis patients.

We have a satellite facility with a heme/onc clinic. They often have their patients come in for blood work the day before their MD visit and order a Blood Bank hold sample. Then they decide the next day if they want the patient transfused. We do no testing until we get an order but the sample is already in the system under the account of the day of collection.

Our outpatient transfusions are usually on recurring accounts. Maybe that is why I haven't had any issues with this.

To branch off a little - - we'll be using exm soon. How did you decide what the cost for this should be in setting up your billing?

Our billing department arrived at the figure. I believe it started at $26 a few years back but it could be higher now. It seems like a lot but considering we get reimbursed less than what we pay the blood center for most blood products....

I was told by the money people that for Outpatients my crossmatch charge has to appear on the same day as the infusion charge - in other words, the date of service refers to the transfusion, not my test date. If the outpatient is done under a recurring visit, which the majority of my outpatient transfusions are, then the crossmatch date and infusion date don't seem to have to match. We do bill the product portion of the charge on the infusion date. This is apparently how it has to be for Medicare if you expect to get paid. The same rule does not apply for inpatients.

We fought this battle for some time with our OP oncology unit. Our director ultimately referenced a regulatory agency standard advising that our date of service was the date of specimen collection.