Starting a Medical Billing Business > Starting Your Own Medical Billing Business

OPPORTUNITY BIG REIMBURSEMENT FROM MEDICARE -$2,100

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diagnostico:
A laboratory contacted me and asked would I market their new DNA/Genetics Test Panel Cytochrome P450 that reimburses well by Medicare. he will charge me $50 to process each sample and then my company can bill Medicare for the lab cpt codes for up to $2,100. Is this legal? How can my company legally bill Medicare or WC or PIP when we don't actually have the lab but we do get the patient approval, lab approval to bill the insurance company. How can we get the checks to come in in our company name and not the labs name? I have seen a company do this exact same thing and get checks from the insurance companies in their company name.
Your help is appreciated.

RichardP:
With any test, be it lab or radiology or whatever, there is the technical component and the professional component.  Technical = whoever performed the lab test or shot the x-ray or whatever.  Professional = whoever interpreted the results of those tests.  Do you do either of those two things.  If not, you have no basis from which to request payment for your services.

The above paragraph is a separate issue from the fact that you can be designated as the receiver of payments from Medicare and other Carriers - as a fiduciary for the end recipient.  That is, you can collect payment on behalf of a doctor, but you must pass that payment through to the doctor.

The distinction is between earning the money versus collecting the money on behalf of the one who earned it.  If you do not either perform the tests or interpret them, you cannot be paid as the earner.

If you are a billing company, you can bill on behalf of the doctor (using his NPI number) and you can bill on behalf of the lab (using their NPI number) and payment will be sent either to the doctor or the lab.  I know it is possible to receive payment in the name of your billing company - on behalf of your clients - but there are registration requirements and other hoops to jump through with Medicare and the insurance carriers in order to make this happen.  But keep in mind that you are still only passing money through to your clients - the money would not be paid to you as the earner.  You can't keep the money.

PMRNC:
CMS has pretty tight rules on reassignment... aside from that you will absolutely NEED a surety bond if you collect monies.  You can also look into a lock box as well.

diagnostico:
RichardP,
That information was very insightful. You know your stuff.
My company, however has contracted the lab to do the work for us. They are like a subcontactor for us. The doctor is sending the samples to a lab hired by us to process the samples.shouldn't that. Matter?

RichardP:
I just added the last paragraph to my post, in case you haven't seen it yet.

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