Drug Screen Billing


Knoxville, TN
Best answers
Was wondering if we have pts sign a Drug Screen Attestation are we allowed to bill them Medicare Rates when their insurance denies as excessive.


Glendale, Arizona
Best answers
So let me preface this response in stating that I am not a healthcare attorney, and that this question does not have a simple answer. I am not sure by why what you meant by a Patient Attestation or how it would relate to the billing of drug screens, or a patient's cost sharing responsibility regarding the testing? How you approach this from a best practices standpoint with the help and guidance of your healthcare attorney is somewhat dependent on whether you are a contracted physician with the insurer doing the testing, or if you are an in-network or out of network reference laboratory.

1. Why is the insurance denying based upon "excessive" is this because frequency limits on testing have been met, or is because your charges for the test are excessive. Some plans only pay for 8 tests per year, but maybe you do 10 because of documented medically necessary reasons.
2. Patient cost sharing is determined and provided on the EOB that you receive from the insurer- you need to collect the patient's co-pays, co-insurance, and deductibles.
3. You should, with your HCA review any state laws that may pertain to OON balance billing if you are an OON provider, and then even if in-network and state insurance laws that may be applicable.
4. If you are an in-network provider, then review all of your payer contracts as there may be requirements that you need to meet from a contractual basis regarding patient cost-sharing.
5. A flat every patient reduction to Medicare rates would not be my recommendation, but again speak to your HCA- in drug testing every patient's testing is different, and best practices tend to lean towards reviewing each EOB and billing the patient appropriately for the services provided.
6. Flat reduction to say Medicare rates of patient cost sharing (co-pays, deductibles, co-insurances) is not a best practice and is an area that commercial insurers are very focused on.

This may be a question that you ask the Legal team at AAPC to review. There is alot of published guidance out there on the pitfalls in flat reductions, waivers of co-pays, deductibles and co-insurances including a OIG Fraud Alert.

Good Luck...