Billing Reminders
Insurance Changes: Please provide accurate insurance that is provided at the time of the patient’s visit. Many patients change insurance plans at the beginning of the year or mid-year, and we need this updated information in order to bill correctly for services. This includes the correct subscriber (person who carries the insurance), their DOB, and the correct policy (member number or identification number) and group numbers.
Diagnosis Codes: Correct diagnosis codes are a necessity. Please ensure diagnosis codes are provided on every order as this is required to bill insurance. Additionally, diagnosis codes must meet medical necessity. If the diagnosis code does not meet medical necessity, then a signed ABN must be submitted with the order. There are several online resources available in order to determine whether a code is covered by insurance. Most private insurance companies follow Medicare guidelines; however, you should consult their coverage policies prior to submission:
o Medicare Local Coverage Determinations
o Medicare National Coverage Determination
o PhysLab Medical Necessity Validation
o Blue Cross Blue Shield of Nebraska Policies and Procedures
o United Healthcare Policies and Procedures
Correct provider: In order to bill insurance, a provider must be indicated on the order. If the patient has Medicare, a PECOS enrolled physician must order the tests. Refer to the following website to determine whether a provider is Medicare approved:
https://data.cms.gov/provider-characteristics/medicare-provider[1]supplier-enrollment/order-and-referring
Select the appropriate billing directives on the order.
o Client Bill – Charges are billed back to your facility.
o Insurance Bill – Charges are billed to the patient’s insurance.
o Patient Bill – Charges are billed directly to the patient (not to insurance).
When the billing information on the order is missing, inaccurate, or the diagnosis provided does not meet medical necessity, the billing team will fax requests to your office weekly. This information is needed to submit the claim to insurance in a timely manner. Please make sure these requests are faxed back with the correct information within one week.
Supply Update
Physicians Laboratory is required to abide by all federal and state laws and regulations. In order to ensure compliance, the following information is provided for review.
The Medicare and Medicaid anti-kickback law prohibits the knowing and willful solicitation, offer, payment, or receipt of any remuneration, whether direct or indirect, in cash or in kind, to induce or in return for referrals for items or service covered by the Medicare, Medicaid, or other government health program. Violations are punishable by civil monetary penalties, criminal penalties, and exclusion from the Medicare and Medicaid programs.
The Stark regulations provide a provision that allows the laboratory to provide low-cost supplies used solely to collect specimens for the laboratory.
It is a violation of law to request supplies for the collection of specimens that are not sent to Physicians Laboratory for testing. This includes supplies that will be sent to other laboratories and/or utilized at the client facility for in-house testing.
Additionally, due to supply chain issues, laboratory and phlebotomy materials are extremely difficult to obtain. Please only order the minimum amount necessary and be cognizant of expiration dates on supplies at your facility. If you are no longer using an item or they are getting near their expiration date, please send these supplies back to our facility.
In order to streamline our order fulfillment process and ensure that clients receive the supplies requested in a timely manner, orders will only be accepted via our online ordering system or by calling our customer service department. Effective April 1st, we will no longer accept orders received by courier, fax, or mail.
To order online, please follow these instructions:
- Go to our website at physlab.com
- Click on the Providers button
- On the right-hand side of the screen click on the Order Supplies Button
- Complete the information on the form including account name and number
To place a phone order, please contact our customer service department at 1(800)642-1117. They will need the name of your facility and your account number to place the order.
ADD ON TESTING FOR THINPREP SAMPLES DISCONTINUED
Effective immediately, Chlamydia, Gonorrhea, and Trichomonas must be ordered on the original requisition. Testing can no longer be added after the Pap smear has been performed on the vial. If a patient needs to be re-collected, these tests can also be performed using a urine sample (see test #2182 and #2000).
EFFECTIVE 07/01/2020, UHC WILL REQUIRE PREAUTH ON GENETIC & MOLECULAR TESTING
Due to this change in policy, the following tests will require preauthorization:
| Test # | Test Name | CPT Code |
|---|---|---|
| 7671 | Actinomyces europeaus by Real-Time PCR | 87798 |
| 7526 | Adenovirus by PCR | 87798 |
| 8355 | Aerobic Vaginitis Panel by Real-Time by PCR | 87798x2, 87640, 87653 |
| 678 | Affirm | 87480, 87510, 87660 |
| 7633 | Aptopobium vaginae by PCR | 87798 |
| 7670 | Bacterial Vaginosis Panel by Real-Time PCR | 87798x3, 87511 |
| 7682 | Bacterial Vaginosis Panel w/ M. mulieris & M. curtisii by PCR | 87798x4, 87511 |
| 7646 | Bacteroides fragilis by Real-Time PCR | 87798 |
| 7662 | BK Virus by RT-PCR Quantitative | 87799 |
| 8201 | Bordetella Pertussis & Parapertussis by Real-Time by PCR | 87798x2 |
| 8136 | BVAB2 by PCR | 87798 |
| 7635 | Candida albicans by PCR | 87481 |
| 7636 | Candida glabrata by PCR | 87481 |
| 7637 | Candida parapsilosis by PCR | 87481 |
| 7638 | Candida tropicalis by PCR | 87481 |
| 7639 | Candida Vaginitis Panel by Real-Time PCR | 87481x4 |
| 2000 | Chlamydia/GC/Trichomonas Panel by PCR | 87491, 87591, 87661 |
| 675 | E Coli by PCR | 87798 |
| 8302 | EBV by PCR, Quantitative | 87799 |
| 8446 | Enteric Pathogen Panel | 87506 |
| 7034 | Epstein Barr Virus by PCR | 87798 |
| 7640 | Gardnerella vaginalis by PCR | 87511 |
| 7674 | Genital Ulcer Disease Panel | 87798x2, 87529x2 |
| 7524 | H1N1 Influenza | 87798 |
| 8337 | Herpesvirus 8 DNA, Quant by RT-PCR | 87799 |
| 7641 | Leukorrhea Panel by Real-Time PCR | 87661, 87491, 87591 |
| 8135 | Megasphaera Species (Type 1 & 2) by PCR | 87798 |
| 7645 | Mobiluncus mulieris & M curtisii by PCR | 87798 |
| 9384 | MTB Complex Detection & Rifampin Resistance by PCR | 87556, 87798 |
| 2431 | Mumps by PCR | 87798 |
| 7629 | Mycoplasma Panel by PCR | 87798x2 |
| 9339 | Norovirus by PCR | 87798 |
| 7723 | Parvovirus B19 by PCR | 87798 |
| 1427 | Respiratory Viral Panel by PCR | 0099U |
| 2442 | Respiratory Viral Panel by PCR (MDL) | 87798x9, 87498, 87634x2 |
| 324 | Rotavirus by PCR | 87798 |
| 7642 | Trichomonas vaginalis by PCR | 87661 |
| 1987 | Trichomonas vaginalis DNA | 87661 |
| 7644 | Ureaplasma urealyticum PCR | 87798 |
| 2405 | Varicella-Zoster by PCR | 87798 |