Hello!
I am wondering if anyone has any resources that can share that talk about whether it is okay to perform pass through billing, and if yes, is it okay if you make a profit? To give a little background, our office is not pass through billing for all labs in order to be profitable, there is only one scenario where we feel it's necessary to file the patient's insurance for them. When a newborn does not receive their newborn metabolic screen in the hospital, and they come into the office for their first visit, we draw the labs and send them to DHEC to process. DHEC will not file the patient's insurance for these labs, and they in turn bill our office. We were billing the patients for the amount that DHEC billed us, but it was causing a lot of unhappy patients. We decided to try billing the labs to the patient's insurance with a 90 modifier showing we did not run these labs in house. We ended up being paid more than what DHEC bills us. Is this okay, or do we need to adjust our charges so that we won't be paid more than what we had to pay for these labs?
Thank you so much!
I am wondering if anyone has any resources that can share that talk about whether it is okay to perform pass through billing, and if yes, is it okay if you make a profit? To give a little background, our office is not pass through billing for all labs in order to be profitable, there is only one scenario where we feel it's necessary to file the patient's insurance for them. When a newborn does not receive their newborn metabolic screen in the hospital, and they come into the office for their first visit, we draw the labs and send them to DHEC to process. DHEC will not file the patient's insurance for these labs, and they in turn bill our office. We were billing the patients for the amount that DHEC billed us, but it was causing a lot of unhappy patients. We decided to try billing the labs to the patient's insurance with a 90 modifier showing we did not run these labs in house. We ended up being paid more than what DHEC bills us. Is this okay, or do we need to adjust our charges so that we won't be paid more than what we had to pay for these labs?
Thank you so much!