Signing orders/test results

aosborn

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Hi,

When a provider orders a test does he have to be the one to sign off on the results in order to bill that test under his name? We have providers that order sleep studies but when the results come back it's another provider that goes over the results with the patient and signs the report but it's being billed under the ordering providers name. Is this okay?

Thanks!
 

alincoln

Networker
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Midlothian, VA
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If you wanted to be very technical about it -
The technical component could be billed under the provider who ordered the test and the interpretation/professional component billed under the provider who read the test.
But that is not usually feasiable or what most insurances want, most prefer to have one line submited on the claim with no modifers and the name of the interpreting physician as billing provider and the one who ordered it as the referring/ordering provider.

No problem! :)
 

ckkohler

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Omaha, Nebraska
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another thought to keep in mind - you could not bill the TC (tech component) unless the physician ordering the test actually "performed" the test .. as in ... owns the equipment. I guess it depends on who your provider is (an internist? a family practice?) .. and the 26 (professional component) should only be billed by the interpreting provider - the sleep study specialist .. for example: if my internist "orders" a sleep study for me ... she could not bill for either the tech or professional component .. she can't bill for simply reviewing the results with me ... that is all part of her E & M fees .
 

aosborn

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Thanks for all the input!

We own the equipment. We have providers here that don't know how to read the sleep study results so they are scheduled for the follow up with the providers that do know how to read the results. They are the ones interpreting and signing the report but the test was billed under the ordering. Soemthing about this deosn't seem right to me...
 

ckkohler

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Omaha, Nebraska
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so, am I correct in understanding that your providers are PERFORMING the test (owning the equipment) but they don't interpret? The providers who READ/INTERPRET the results - are they part of your organization as well? If yes, then, you should be billing the whole thing (technical and professional) ... just one time .. without a modifier. If the providers interpreting are not part of your organization and you send the report out to be read - then you would bill your portion with the -TC modifier (for technical component) and the provider interpreting the results would bill with the -26 modifier (for professional services); I would be interested in how others view the situation. Hope my thoughts are helpful!
 

mhstrauss

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Baton Rouge
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so, am I correct in understanding that your providers are PERFORMING the test (owning the equipment) but they don't interpret? The providers who READ/INTERPRET the results - are they part of your organization as well? If yes, then, you should be billing the whole thing (technical and professional) ... just one time .. without a modifier. If the providers interpreting are not part of your organization and you send the report out to be read - then you would bill your portion with the -TC modifier (for technical component) and the provider interpreting the results would bill with the -26 modifier (for professional services); I would be interested in how others view the situation. Hope my thoughts are helpful!
I agree with this. We bill only for the 26--our docs actually interpret the study and make a report. They are usually the ordering physician also, but thats irrelevant. The study is actually performed in our surgical hospital, which is a separate entity, and they bill for the TC.
 
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