n2horses
Guest
I may be making this more complicated than it really is but I need advice from anyone billing for a physician office with an "in-house" lab.
My client is a large pain management practice. They recently applied for a high complexity CLIA certificate and were approved. The lab will be in the rear space of their new corporate headquarters, which is not where patients are seen. No samples are collected in the lab; they are collected in the other physician offices ( 4 locations), and shipped to the corporate headquarters where the lab resides. They intend to begin sending their patient samples to their own, in house lab in 2018 instead of using outside vendors.
The performing providers who managing the patients will be ordering Definitive Drug Tests. The lab will be staffed with appropriate,skilled technicians and a medical director as per CLIA requirements for this level of testing.
The lab shares the same TIN as the physician practice. Because the lab is NOT independent of the physician office, even though it does not reside within the physical walls of the practice locations, the claims cannot be coded with POS 81, correct? They must go with POS 11?
Does anyone know what the reimbursements rates are, or if the insurances will even accept the claims with the CLIA, definitive drug test cpt codes on it, the labs physical address and information, referring/ordering provider of the test, and POS 11 on it and pay? Is anyone in this similar instance and getting paid? Is the reimbursement more or less than an independent lab? I need to advise my client that if this is not a profitable venture to have an in-house lab for this level of service, they should cease immediately.
I guess I am confusing myself because the referring provider is not performing the test, the place of service is 11, and in a lab, you do not put the name of the performing lab tech as the rendering provider. The TIN is shared between the practice and the lab, so how will the insurance differentiate, and not reject the claim for inappropriate CPT, or POS??
PLEASE HELP!!
My client is a large pain management practice. They recently applied for a high complexity CLIA certificate and were approved. The lab will be in the rear space of their new corporate headquarters, which is not where patients are seen. No samples are collected in the lab; they are collected in the other physician offices ( 4 locations), and shipped to the corporate headquarters where the lab resides. They intend to begin sending their patient samples to their own, in house lab in 2018 instead of using outside vendors.
The performing providers who managing the patients will be ordering Definitive Drug Tests. The lab will be staffed with appropriate,skilled technicians and a medical director as per CLIA requirements for this level of testing.
The lab shares the same TIN as the physician practice. Because the lab is NOT independent of the physician office, even though it does not reside within the physical walls of the practice locations, the claims cannot be coded with POS 81, correct? They must go with POS 11?
Does anyone know what the reimbursements rates are, or if the insurances will even accept the claims with the CLIA, definitive drug test cpt codes on it, the labs physical address and information, referring/ordering provider of the test, and POS 11 on it and pay? Is anyone in this similar instance and getting paid? Is the reimbursement more or less than an independent lab? I need to advise my client that if this is not a profitable venture to have an in-house lab for this level of service, they should cease immediately.
I guess I am confusing myself because the referring provider is not performing the test, the place of service is 11, and in a lab, you do not put the name of the performing lab tech as the rendering provider. The TIN is shared between the practice and the lab, so how will the insurance differentiate, and not reject the claim for inappropriate CPT, or POS??
PLEASE HELP!!