PASS-THROUGH BILLING?

[tperian]

I HAVE BEEN READING UP ON PASS THROUGH BILLING.  IS THE FOLLOWING SCENARIO PASS-THROUGH BILLING?

IF I  HAVE AN ULTRASOUND TECH OR AN EKG TECH OR A SONOGRAPHER WHO IS IN PARTNERSHIP WITH A PHYSICIAN (ALSO THE MEDICAL DIRECTOR).  THE TECH PERFORMS THE TC AND THE PHYSICIAN PERF0RMS THE 26 PORTION.  THE PHYSICIAN IS NOT A MEMBER OF THE THE ULTRASOUND TECH'S COMPANY BUT IS INSTEAD PAID FOR HIS SERVICES BY THE TECH.  THE TECH THEN BILLS THE INSURANCE FOR THE GLOBAL.

PASS THROUGH BILLING?

[Michele]

That is how our guy does it.  I have never heard of it referred to as "pass through billing" but it does meet the description.

[tperian]

I WAS ABLE T OLOCATE THIS INFORMATION...
“Pass-through billing” is the term for submitting a claim for anything not delivered by the submitting physician or someone in their direct employ. A common example is when practitioners have ordered lab tests and taken care of the billing, even though they are not part of the lab that did the testing. Jun 30, 2021

Pass-through bills are considered unethical and illegal because the healthcare providers or their staff request billing for a service that is not provided by them. The billing provider increases its profit by charging for a service that they did not perform. This is illegal and may hurt the credibility of the practice. Oct 1, 2020

---AM I INTERPRETTING IT CORRECTLY TO SAY THAT IF WE WERE TO BILL THE INSURANCE COMPANY FOR THE 26 PORTION AT THE SAME PRICE AS WE WOULD BE CHARGED FROM THE ACTUAL SERVICE PROVIDERE, THEN WE ARE WITHIN PARAMETERS TO LEGAL PASS-THROUGH BILL?

---IS THERE A ,ODIFIER YOU USE TO SHOW THAT?

THANKS SO MUCH FOR THE HELP!

[Michele]

I re-read your initial post.  I don't believe that is the same as pass through billing.  The tech, who owns the company is providing the service of the ultrasound or EKG, they pay someone to perform the professional component, and they bill the insurance for the global fee.  That is not having someone else perform a service and then charging more to the insurance carrier.  Also, the tech/company is billing the insurance, and (I'm assuming) is contracted so they accept their rates.  They are not financially benefiting from paying the Dr to read the xray and then charging more.

[tperian]

MICHELLE, THANKS SO MUCH FOR YOUR INPUT.  I AM FAILING TO SEE THE DIFFERENCE IF SHE IS NOT BILLING THE INSURANCE CARRIER FOR THE EXACT AMOUNT THE "READER" IS CHARGING...
“Pass-through billing” is the term for submitting a claim for anything not delivered by the submitting physician or someone in their direct employ. A common example is when practitioners have ordered lab tests and taken care of the billing, even though they are not part of the lab that did the testing. Jun 30, 2021
 
Pass-through bills are considered illegal because the healthcare providers or their staff request billing for a service that is not provided by them. The billing provider increases its profit by charging for a service that they did not perform. This is illegal and may hurt the credibility of the practice. Oct 1, 2020

The costs of Services determined by the Pass-Through Billing method shall be equal to the third-party costs and expenses actually incurred by the Party providing the Services. It is extremely essential that you properly document an unlisted cost.

[Michele]

OK, so rereading the definition of pass through billing, I understand what you are thinking.  I have seen pass through billing mostly with labs.  The provider billing the insurance for the labs doesn't perform the tests, but sends the bills in for a much higher amount than they paid the lab that did the testing.  So with the radiology, I was thinking they are billing for the global service, but paying someone to read the xray.  So it seemed different.  But after rereading the definition I see that it really is the same thing.  I am not a legal expert so I would advise that someone with experience in legal medical issues be consulted on this question.  I tried to research it more, but couldn't find anything.