Author Topic: Procedure done before insurance termed, lab done after.  (Read 2048 times)

workerbee

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Procedure done before insurance termed, lab done after.
« on: January 26, 2014, 03:55:04 PM »
I have a conundrum.  A patient had a procedure to slice something off of their skin two days before their insurance terminated, so the procedure was covered.  But the specimen that was sent to the lab was not tested until the day after the patient's insurance terminated, so it wasn't covered.  The lab billed it with the date they did the testing as the date of service on the claim.  The patient called me upset.  Can the lab testing be re-billed with the date of service of the procedure on the claim instead of the date of the testing?  What is the protocol for this?

Michele

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Re: Procedure done before insurance termed, lab done after.
« Reply #1 on: January 27, 2014, 09:43:06 AM »
I do not believe so.  Even though the specimen was obtained when the patient had insurance, if the pathology test was performed two days later then the date of service would be the date the pathology test was conducted.   :(
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shanbull

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Re: Procedure done before insurance termed, lab done after.
« Reply #2 on: January 27, 2014, 12:06:29 PM »
The insurer might agree to cover it in this circumstance but I would tell the patient in this case that it's between him/her and his/her insurance company and the outside lab. Since this isn't even about the service you provided (but rather the outside lab), you aren't in a position to be able to do any negotiating.

PMRNC

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Re: Procedure done before insurance termed, lab done after.
« Reply #3 on: January 28, 2014, 12:25:09 PM »
I don't agree.. I'm guessing with the words "procedure to slice something off their skin"  :o ANY care would be in the global period. My daughter had cut herself and got stitches, she terminated with our plan 2 days later.. she had to go back for post op infection and antibiotics but it was ALL covered under the global period. The carrier denied the follow-up for term date but I had called and they pulled an oopsie and saw it was for same procedure.  So I'm not agreeing that provider is SOL . Also you can split hairs here because the "specimen" was taken and lab is one that tested it afterwords.. This has successful appeal written all over it, IF I READ THIS CORRECTLY.

Quote
I have a conundrum.  A patient had a procedure to slice something off of their skin two days before their insurance terminated, so the procedure was covered.  But the specimen that was sent to the lab was not tested until the day after the patient's insurance terminated, so it wasn't covered.  The lab billed it with the date they did the testing as the date of service on the claim.  The patient called me upset.  Can the lab testing be re-billed with the date of service of the procedure on the claim instead of the date of the testing?  What is the protocol for this?
Linda Walker
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KarenH

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Re: Procedure done before insurance termed, lab done after.
« Reply #4 on: January 28, 2014, 09:00:19 PM »
Devil's Advocate here... depends on whether the pathology lab is a different facility and billed for the technical component after the insurance was termed which it sounds like that's the case.
Devil's Advocate again... if they appeal stating that this should have a billed the date of when the specimen was taken they may have a chance. That would be the only way I see an appeal not sure if it would fall under global because of 2 different facilities though.

PMRNC

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Re: Procedure done before insurance termed, lab done after.
« Reply #5 on: January 29, 2014, 12:40:37 PM »
Hmm but patient has no control over "facility" used.. the services are still related to the global billing period.. certainly if the patient could control where and when the specimen was tested it would be different?
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Merry

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Re: Procedure done before insurance termed, lab done after.
« Reply #6 on: January 29, 2014, 06:05:05 PM »
Agree with Karen. Global period relates to procedure.. not the lab done at an outside facility. If the physician did the TC then it would be covered. And many small procedures don't even have a global period.
 

PMRNC

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Re: Procedure done before insurance termed, lab done after.
« Reply #7 on: January 29, 2014, 07:08:47 PM »
Read this again:

Quote
A patient had a procedure to slice something off of their skin two days before their insurance terminated, so the procedure was covered.  But the specimen that was sent to the lab was not tested until the day after the patient's insurance terminated, so it wasn't covered.  The lab billed it with the date they did the testing as the date of service on the claim.  The patient called me upset.  Can the lab testing be re-billed with the date of service of the procedure on the claim instead of the date of the testing?  What is the protocol for this?

Answer is NO lab can't and shouldn't change dates of service. Something forgotten and not asked is why is patient calling YOU upset? wouldn't they appeal this with the lab? YOUR date of service is day the specimen was collected.
Linda Walker
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www.billerswebsite.com

KarenH

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Re: Procedure done before insurance termed, lab done after.
« Reply #8 on: January 31, 2014, 11:12:56 AM »
Agreed lab can't change the date of service the date of service can only be for the date the service was actually done. This is what I would do as a patient- contact your insurance company both the old and new carriers appeal to them. I would keep the doctor's office out of it because there is nothing they can do it's a different facility.