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My patient is “Family Pact”— Is there anything
that I have to do differently?
Does the doctor’s office have to provide the patient’s
“chief complaint” or
 “reason
for office visit” when submitting a non-gyn specimens even if we
don’t
know the diagnoses?
Do we have to fill in the patient’s address and
insurance information on every
requisition?
We heard that the laboratory maintains a database file of
previous
patients’ billing information.
Do we have to include the ICD-9 Code on the Gyn
Cytology Requisition?
Is the HPV DNA test covered by my patient's insurance?
Do we have to use the full 5-digit ICD-9 code?
My patient received a bill from the laboratory. Why did
the laboratory not bill
the
patient’s insurance?
Can my patient pay for laboratory services by credit
card?
We have a tissue biopsy. What size formalin container
should I use?
We are submitting a POC specimen. Is there anything
that I have to do
differently?
How do I submit a kidney stone or bladder stone for
analysis?
The HPV DNA was not ordered at the time the PAP
was taken. Can the test
be
added on?
Why
am I receiving a bill?
My
statement shows more than one charge for the same date of service,
is
this a duplicate charge?
I
am a Medicare patient, why is my pap test not covered?
I
gave my insurance information to my Doctor, why are you billing me?
Why
do I have a balance due?
I
have a secondary insurance why am I receiving a bill?
Why
do I have different account numbers?
I
have a “workers compensation injury” why are you billing me?
My patient is “Family Pact”— Is there anything
that I have to do differently?
Family Pact is a special Medi-Cal program; your staff should be
trained and certified by Medi-Cal on how to handle these patients.
Does the doctor’s office have to provide the patient’s
“chief complaint” or
“reason
for office visit” when submitting a non-gyn specimens even if we don’t
know the diagnoses?
Yes. From the General Coding Guidelines, AMA 2005 ICD-9-CM: “Codes
that describe symptoms and signs, as opposed to diagnoses, are
acceptable for reporting purposes when a related definitive
diagnosis has not been established (confirmed) by the physician.”
This information is necessary for the laboratory
to properly file a claim with your patient’s insurance.
Do we have to fill in the patient’s address and
insurance information on every
requisition?
We heard that the laboratory maintains a database file of
previous
patients’ billing information.
Yes. Submitting the patient’s correct and current address and
insurance information helps both the laboratory and the patient. The
laboratory can properly file a claim with the patient’s insurance,
which in turn will save the patient from receiving unnecessary
billing and paperwork. Because many patients will change
insurance during the year, the laboratory does not maintain a
database file on patient's previous billing information.
Do we have to include the ICD-9 Code on the Gyn
Cytology Requisition?
Yes. From an insurance perspective, the Pap test is either a
screening Pap test (patient is asymptomatic) or a diagnostic Pap
test (gynecologic signs, symptoms, or abnormal history). Patients
undergoing screening Pap tests can be further divided into low-risk
and high-risk patients. The medical necessity ICD-9 Code conveys
these distinctions, and, depending on the insurance coverage
benefits, ICD-9 coding will impact payment for the Pap test.
Is the HPV DNA test covered by my patient's insurance?
Many insurance plans will cover the expense for the HPV DNA test. If
you are unsure, please contact your patient's insurance provider or
the laboratory.
Do we have to use the full 5-digit ICD-9 code?
Yes, if the code goes to 5-digits. Some codes only go to 4-digits.
Using the proper ICD-9 Code makes billing claims easier for both the
laboratory as well as your patient. ICD-9 Codes update annually.
Please be sure to use current ICD-9 Codes.
My patient received a bill from the laboratory. Why did
the laboratory not bill
the
patient’s insurance?
There are several possible answers to this question:
-
The laboratory billed the patient’s insurance; the balance now due
is the co-pay, deductible, or balance after the patient’s insurance
response to our claim.
-
The insurance information provided was incomplete or the patient
was no longer eligible for the insurance provided.
-
The laboratory did not receive the patient’s insurance information
and therefore, the laboratory assumed this was a cash patient.
Can my patient pay for laboratory services by credit
card?
Yes. The laboratory will accept payment by VISA and MasterCard.
Please include the entire account number as well as the expiration
date on the requisition.
We have a tissue biopsy. What size formalin container
should I use?
The appropriate size container should be able to hold the specimen
and enough formalin to completely cover the specimen. For small
biopsies a ratio of 15 to 1 (fifteen parts formalin to one part
tissue) is suggested. Formalin containers are available at no charge
from the laboratory.
We are submitting a POC specimen. Is there anything
that I have to do differently?
Yes. The Non-Gyn Tissue Requisition needs to include information as
to whether the specimen is a missed abortion, spontaneous abortion,
legally induced abortion and the appropriate ICD-9 coding. The POC
specimen is best submitted in formalin unless the specimen is to be
submitted for Chromosome Analysis. If the specimen is to be
submitted for Chromosome Analysis, place the specimen in the
laboratory provided screw-top tubes with sterile transport medium.
Approximately 1cc of tissue which includes chorionic villi should be
placed in the transport tube.
DO NOT PLACE IN FORMALIN. For further information, please contact
the laboratory (818-992-7848) for a fax copy of “Protocol for
Handling POC’s for Chromosome Analysis and/or Genetic Studies”.
How do I submit a kidney stone or bladder stone for
analysis?
Place the stone in a clean, dry container.
DO NOT PLACE IN FORMALIN.
Complete the Non-Gyn Requisition (blue) and submit the specimen to
the laboratory.
The HPV DNA was not ordered at the time the PAP
was taken. Can the test be
added on?
Yes, provided the Pap is ThinPrep®. The laboratory retains the
ThinPrep® vials for approximately three weeks. HPV DNA testing, as
well as Chlamydia and Gonorrhea testing, can be done during this
time period. Please fax a request for the add on test to:
818-992-7943.
Why
am I receiving a bill?
We are a pathology group that
processes and reviews specimens, including tissue biopsies, pap
test, fluids and organs removed during surgery. Your specimen(s) may
have been sent to us by your Doctor or by a hospital. Your Doctor
may have done a surgical procedure on you and sent your specimen to
our pathology laboratory for processing and reporting, or you may
have been a patient at Encino Tarzana Regional Medical Center. Not
all specimens are obtained during a hospital surgical procedure.
Sometimes specimens are obtained from your the doctors office.
My
statement shows more than one charge for the same date of service,
is
this a duplicate charge?
Our pathology laboratory processes the specimen, and
the pathologist performs an individual examination of the specimen
to arrive at a pathologic diagnosis. You will see two charges, one
for the technical component ( TC ), processing of the specimen, and
another charge for the professional component ( 26 ), the
pathologist examination of the specimen and the written narrative
report he prepares. Note: these charges may share a portion of the
same billing code but will show a suffix of either a TC or 26. These
charges are also priced at different dollar amounts.
Charges are based on the type and number of specimens received from
different surgical sites and current billing regulations dictate
that each separate site be individually billed. On occasion the
pathologist may need to order additional test on your specimen, for
example, a special stain may be ordered to validate your diagnosis.
The additional service will be charged.
I
am a Medicare patient, why is my pap test not covered?
Medicare will only pay for one screening pap test
every two years. Your Doctor may ask you to sign an Advanced
Beneficiary Notice ( ABN ). This ABN notice informs the patient in
writing that this screening pap test may not be paid by Medicare if
this same test has been performed within the past two years.
I
gave my insurance information to my Doctor, why are you billing me?
We may not have received your insurance information
from your Doctor. If you received a statement you need to call our
billing department at your earliest convenience. We will need to
obtain or verify your insurance information so we may submit a bill
for your services.
Why
do I have a balance due?
Many insurance plans have deductibles and
co-payments, and contractually we are obligated to bill for these
amounts due. If you feel your have received a bill in error, call
our billing department to discuss your statement. You may also want
to call your insurance company to ensure you understand your health
plan benefits.
I
have a secondary insurance why am I receiving a bill?
Interscope will bill any secondary insurance after
the primary insurance has paid. Medicare electronically forwards the
charge and payment information to a number of secondary insurances
on file with Medicare. Secondary insurances may make payment
directly to the patient regardless if an “assignment of benefits” is
on file. If you feel you have received a bill in error please call
the billing department at your earliest convenience.
Why
do I have different account numbers?
Each new occurrence will receive a new account
number. We have two different types of laboratory services,
pathology laboratory and clinical laboratory. Each will have
separate account numbers. Should you have any questions regarding
your account please call the telephone number on your bill at your
earliest convenience.
I
have a “workers compensation injury” why are you billing me?
It is possible we did not receive your workers
compensation information from your Doctor or the hospital. If you
are workers compensation patient you will already have a case number
and a prior authorization number for this service. Please call the
billing department with this information immediately so we may bill
your workers insurance for these services.
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