Billed Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Billed and links to relevant pages within the course.
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| Written and verbal orders All tests must have a written order on file.
Any verbal orders for tests including tests added on to a specimen already in the lab, must be followed up by a request for a written order.
Employee who receives a verbal or add-on order must follow procedures to ensure that a follow-up written order is requested.
It is against Medicare regulations to bill extra for calculated test results. Only appropriate tests actually performed may be billed.
It is against the law to bill for the same tests or services twice (duplicate billing).
It is against the law to bill for quality control tests or tests performed multiple times to check or verify the results.
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| Panels and profiles Panels and Profiles:
It is not against the law for a laboratory to allow the use of panels, profiles and custom panels.
The laboratory must ensure that the ordering doctor knows what tests are included in a panel or profile and what CPT codes will be billed to the Medicare program.
The laboratory notifies doctors about panels and profiles through a written notice and the requisition.
Employees should not permit the order of any panel or profile not authorized by the laboratory.
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| Test pricing and antitrust It is not against the law for a laboratory to have different fee schedules for different billing situations.Most laboratories have one fee schedule for customers that must be billed individually (patients, insurance, Medicare) and one for customers billed monthly on an invoice type of statement (client or doctor billing).The difference in price between the two schedules should be a reflection of the financial benefits of direct client billing.Test prices should be determined by means of a financial analysis that include such factors as cost, market value and reasonable profit.Contractually arranged pricing that results from negotiations with insurance and managed care companies should at least cover costs of testing.Laboratories may not work together to fix or set prices in the market place. | View Page |
| Case Study 4 Busy hospital laboratory in a 350 bed urban hospital that provides laboratory testing for the hospital and for the hospital's outreach testing laboratory. A medical technologist in the microbiology department receives a call from a friend who works in a laboratory in a physician office. The physician is not a regular client of the laboratory currently but uses another laboratory for most of their work. The microbiologist knows that the sales department would like to get this account. The friend explains to her that she is doing a quality control check on her in-office microbiology testing and her regular laboratory will do it but is going to charge her for it. She asks the microbiologist if she will do it for free since it is quality control, not Medicare and is not going to be billed to anyone.She tells the microbiologist that she would like to use the hospital lab for everything but her doctor insists on using the competitor. She indicates that the favor might help get the doctor to try the hospital laboratory for other tests. The microbiologist should:Correct Answer: Explain to her friend that if the hospital does the tests for no charge on the promise of other referrals, both the physician office and the hospital could be liable for violations of the antikickback statute.Discussion: The antikickback statute is implicated in this scenario because the free testing is solicited on the condition that other referrals may occur as a result of providing the favor. In fact, the solicitation itself is a violation of the law. The fact that Medicare patients are not specifically mentioned in the scenario is not sufficient to remove the risk. The technologist should also report the incident to the Compliance Officer and seek advise about what documentation, if any, should be kept concerning the incident. | View Page |
| Case Study 1 A billing clerk is entering billing demographics on requisitions as a part of the normal days work. The department is under pressure to reduce accounts receivable, which means that the more clean claims that are filed, the better. This particular requisition is for a Medicare patient and has an LMRP test but does not have a diagnosis on it. She remembers that just a few requisitions before this one she had a requisition from the same doctor that had this same test on it that did have a diagnosis that allowed the test to be billed. She thumbs back in the pile and finds the previous requisition, notes the code that was used and adds it to the current requisition. This will help her meet the department goal of getting claims paid and reducing accounts receivable. It is all right for her to do this because:Correct Answer: She should not do this because it is against the law to change diagnosis information on a requisition.Discussion:
A laboratory employee should never change, add or use previously received diagnosis information for the purpose of making a test billable for the Medicare program or for any other insurance or payer. This is a form of fraud and for each claim submitted as a result of this activity the laboratory is liable for a false claim and would have to pay the government back three up to times the reimbursement for the test and up to $10,000 for each claim submitted. Further, if the employee is caught doing this, even if the employee is ignorant of the law and any laboratory policy prohibiting it, she must be disciplined and so should the supervisor. Any employee who notices another employee doing this should correct the employee and report the incident to the department supervisor immediately. | View Page |