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Pathology/Lab Coding Alert

Reader Question:

Abide by Contractual Fee Schedule

Published on Wed Jul 04, 2012

Question: Our lab changed the type of kit we use to test for bilirubin in whole blood. The new test is much more expensive, and measures alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, total bilirubin and urea levels. Now we're finding that the amount the insurer allows for a bilirubin test is well under our cost. If I bill the insurer, I am bound by our contract with them to write off the provider discounted amount. Can I just bypass billing the insurer and offer the patient the option of purchasing the test without insurance? Missouri SubscriberAnswer: No, you cannot bypass billing the insurer and "offer" the patient the option to pay out-of-pocket. If you are contracted with the insurer, then you agreed to abide by the payer's fee schedule and accept that payment as payment in full. That is a contractual obligation. You can't just bill the patient [...]
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