Wiki Post Vas specimens

[alp.jeffrey]

We had a rep come into the office advertising post vas specimen kits. These kits would be sent to the patient's home and they would mail in the specimens to their lab for analysis.

We've always done our post vas specimens in office and we don't bill because it's included in the 55250 code.

So, does anyone else use a service like the one above to do their specimens? It feels almost like double dipping or something to do this to me.

 

[kschaefer13]

If we charge out 55250 but do not offer post vas analysis do we need to add a modifier to reduce the service? The office is not wanting to offer the analysis in the office and have them use an at-home service and pay for it themselves.

 

[CBLENNIE]

I would only think it is double dipping if the patient is charged for the post vas specimen kits and your provider received full reimbursement for 55250. Did the rep for this company say who would pay for these services and how they'd bill for them? Are they offering to let your practice purchase these kits but ship them to the patient, or are they suggesting they would submit claims to the patient's insurance carrier?

Also, if they were going to be billing the patient's insurance and your practice is going to change how you bill 55250 to indicate a reduction in services since you won't be performing the post vas analysis? Is this provider contracted with the major insurance carriers that the majority of your patients are covered by. If they aren't contracted with the patient's insurance, the patients are likely going to get stuck with an unexpected out-of-network bill and who knows how much they will be charged as these novelty labs tend to charge quite high prices. If you are contracted with the insurance company, you are most likely obligated to use in-network labs for the patient's insurance based on the carrier's administrative policies and/or potentially your actual provider network agreements with the insurance company.

This proposed service is creating numerous questions and concerns in my opinion as someone who works for an insurance company. I have performed audits, worked in member appeals dealing with these types of out-of-network labs, also in our Payment Integrity unit and now in compliance so I tend to look at things through the lens of member harm because of the unexpected out-of-network lab claim and potential improper billing of services by this provider.

I would caution you to move cautiously before moving forward with this service and think of what the costs might be for your patients. How would you feel if you were in their shoes, and you got hit with an unexpected out-of-network lab bill.