Illegal Billing ?

[Lolasworld]

Is it illegal not to bill insurance companies, for medical services performed on patients?

[SLITTLES]

Who is getting billed if not the insurance companies are you just billing the patients??

[Lolasworld]

someone is billing the PC portion, we did the TC portion but not billing it.

[SLITTLES]

I don't know if it's illegal but it is definitely a loss of revenue.

[PMRNC]

I don't know if it's illegal but it is definitely a loss of revenue.

I was gonna say that AFTER I asked . WHY?

[Lolasworld]

We are a lab, and our clients are upset that their patients are recieving Eob's that claims are out of network we are not billing the patients. My boss here doesnt want to lose the client so has decided not to bill for the TC portion i'm just worried if there was ever an audit we would get in trouble and does this violate the stark law. The Pc portion is being billed out by the client so the Tc has to be performed by somone, so where is the bill? Just worried.

[PMRNC]

Ahh.. Ok. OUCH. .. I say ouch if there is a financial relationship between your clients (providers) and your facility, yes indeed you have some stark issues.. EVEN if your not billing insurance companies..   Depending on the "arrangement" you might want to have your boss/client check with his/her attorney.   Here's problem I see.   IF there is NO financial link between the lab/provider.. well then how are you getting paid? By violation of stark the lab shouldn't get more than the services are worth, so hopefully the financial relationship does not go beyond that.  IF the provider is NOT being compensated by the provider.. the obvious next question would be, then who's paying them? Can't be working for free.   As the biller it's good to see your asking this because it could be a problem for you as well since you do the billing.