Medical Billing Forum

Billing => Billing => : midwifebiller March 03, 2010, 08:44:29 PM

: Provider billing labs
: midwifebiller March 03, 2010, 08:44:29 PM

A provider draws blood in the office, then sends it to the lab for processing.  The lab refuses to submit claims to the patient's insurance company and bills the provider instead. Can the provider submit a claim to the insurance company for the lab (in addition to the blood draw)?  Is a modifer needed?

Thank you,
Kelli

: Re: Provider billing labs
: medauthor March 04, 2010, 01:54:55 AM

Kelli,

I am confused ???  Why is the lab refusing to bill the pt's ins company?  Was the patient required to go to a specific lab per her ins co and this is not the lab that the provider sent the blood to?

: Re: Provider billing labs
: Michele March 04, 2010, 01:39:17 PM

I was wondering the same thing.  Did the provider know prior to the services that the lab was going to bill him directly? 

Michele

: Re: Provider billing labs
: midwifebiller March 04, 2010, 04:38:05 PM

Many labs will not contract with a midwife for whatever reason: practice is too small, they are not physicians, they are out of network with the insurance companies, etc., etc.  It's very common.

So the midwife gets stuck with the lab bill and her clients want her to submit it to their insurance company.  Can she?  I have heard (vehemently) both yes and no and am trying to get direction.

Thanks!
~Kelli

: Re: Provider billing labs
: medauthor March 05, 2010, 12:20:46 AM

Kelli,

I've never done your type of billing, so I don't want to sound dumb....but if a patient chooses to use the services of a midwife versus an OB, and the patient is aware that the midwife is not contracted with the labs for insurance carriers, why can't the patient be responsible to pay for the labs and then the patients submit the bill themselves to see if any reimbursment is sent to them for out-of-network benefits?? ???

: Re: Provider billing labs
: midwifebiller March 05, 2010, 02:39:18 AM

The patients can submit the claim themselves, and many midwives do operate this way. The argument is that the midwife (or any provider) CANNOT legally submit claims to the insurance company, but must have the patient submit the claims themselves.  I disagree. I believe a provider can bill the insurance company directly for lab work as long as the modifier -90 is used, but am looking for someone who knows more than I do to say yay or nay.

Any thoughts?

~Kelli

: Re: Provider billing labs
: Michele March 05, 2010, 10:55:12 AM

I'm with MedAuthor on this, I haven't done this specific billing either.  But wouldn't this be where you would use box 20 on the CMS? 

I would also recommend contacting a provider rep for one of the larger insurance carriers and asking them for assistance.  They may be able to help you out.

Good luck!

Michele

: Re: Provider billing labs
: PMRNC March 05, 2010, 09:09:02 PM

The patients can submit the claim themselves, and many midwives do operate this way. The argument is that the midwife (or any provider) CANNOT legally submit claims to the insurance company

That's correct. The patient has to file the claim. The midwife simply needs to give the patient a copy of the bill, no big deal.

: Re: Provider billing labs
: midwifebiller March 07, 2010, 04:18:10 AM

Thanks Linda.  May I know where you get your information?