Wiki Newborn Metabolic Screening S3620

[clinic@goldenwellness.net]

We have been getting denied reimbursement from all but state Medicaid for the S3620 ($190.50) the state charges our clinic/birth center for the state mandated newborn metabolic screening. I talked with the state program and how the legislation reads, the program can't charge the patient directly and it is supposed to be 100% covered by the health plans per state and federal law. We collect and prepare the blood samples the send it off to the state lab, our clinic gets the bill. I have spent 2 months searching every thing I can find to make sure I am billing it correctly, and it appears that I am. I have spent close to 60 hours on the phone with various insurance companies trying to get it pushed through.

Any ideas?

 

[nielynco]

We have been getting denied reimbursement from all but state Medicaid for the S3620 ($190.50) the state charges our clinic/birth center for the state mandated newborn metabolic screening. I talked with the state program and how the legislation reads, the program can't charge the patient directly and it is supposed to be 100% covered by the health plans per state and federal law. We collect and prepare the blood samples the send it off to the state lab, our clinic gets the bill. I have spent 2 months searching every thing I can find to make sure I am billing it correctly, and it appears that I am. I have spent close to 60 hours on the phone with various insurance companies trying to get it pushed through.

Any ideas?

It sounds to me that you might want to contact some AAPC certified coders in your state to see what they have been doing. I checked the legislation and do not understand why you are being charged for the test when you did not do any work but the collection. Is is possible that only your Medicaid program recognizes the S3260? Or that the payer does not allow indirect billing? Have you added a modifier -32 to the S code to see if that helps it go through and also a modifier that indicates you are billing on behalf of an outside lab. Just some thoughts.