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Billing & Medicare CompliancePhenoPath Laboratories provides laboratory testing for clients nationwide and internationally, and offers a variety of billing options.
Client BillingPhenoPath will bill the referring client (laboratory, hospital or physician) for the tests requested at the negotiated fee schedule when the client has so indicated on the requisition form. The referring client also will be billed directly for services if no specific instruction is given in the "BILL TO:" section of the requisition. In completing the requisition form, the patient's full name, sex, and date of birth is required, as well as the ordering physician's full name. The patient's social security number is helpful as a second form of identification but is not required for client billing. If you have been billed directly for laboratory services and wish to make a change, any requests to change from "BILL REFERRING LAB" to "BILL PATIENT/INSURANCE" must be received within 60 days of the date of service. Client invoices are processed the first week of each month for the prior month. Terms of payment are net 30 days. Payments are to be mailed to:
Patient BillingPhenoPath will bill patients directly if this is indicated on the requisition form. In completing the requisition, the patient's full name, sex, date of birth, address, and telephone number are required, as well as the ordering physician and clinician's full name and UPIN. (Most patients will not recognize the pathologist's name.) We also ask that you provide diagnosis information and the patient's social security number on the requisition so that third party billing can be easily accomplished at a later date should that be requested by the patient. Third Party BillingPhenoPath Laboratories will also bill third party payers directly if this is indicated on the requisition. When completing the requisition form, the patient's full name, sex, date of birth, social security number, address, telephone number, and diagnosis information are required, as are the full name and UPIN for: the referring pathologist, the ordering physician (if different), and the clinician. Also required are the insurance company name & address, policy number, group number and/or certificate number. It is helpful to include a copy of the patient's insurance card with the requisition. Depending on the patient's insurance plan and whether PhenoPath Laboratories is considered "in-network," the patient may be responsible for the entire bill, co-pays or deductibles. If PhenoPath has received incomplete or incorrect information, our billing office representative will contact the referring client's office to obtain the data necessary to bill our services. If the client's office is unable to provide the necessary information, we will bill the client for the services. Medicare/Medicaid BillingPhenoPath will also bill Medicare Part B and Washington state Medicaid (DSHS) programs, as allowable by law. The following information must be provided with the test requisition form: patient's full name, sex, date of birth, social security number, address, telephone number, Medicare or Medicaid number, diagnosis information, the full name and UPIN for: the referring pathologist, the ordering physician (if different), and the clinician. It is often helpful to include a copy of the patient's insurance card with the requisition. If PhenoPath has received incomplete or incorrect information, our billing office representative will contact the referring client's office to obtain the data necessary to bill our services. If the client's office is unable to provide the necessary information, we will bill the client for the services. Advanced Beneficiary Notice ("ABN")The Centers for Medicare and Medicaid have established guidelines for determining the medical necessity of various laboratory tests. These guidelines determine when the tests will and will not be reimbursed by federal programs. If your facility orders a test(s) that the referring physician believes may not meet Medicare's medical necessity guidelines, it is important that you complete an ABN and have it signed by the patient at the time of service. This will allow PhenoPath to bill the patient for the test(s) ordered if Medicare does not reimburse us for the test(s). If the patient does not sign an ABN and Medicare fails to reimburse PhenoPath for the test(s) ordered, we will have no recourse but to bill the referring lab/physician for the test(s) ordered, as failure to do so could invoke the anti-kickback statutes that pertain to physician/laboratory relationships. Billing Office InformationQuestions on invoices should be directed to our Medical Billing department at 1-866-927-4366 or 206-374-1480. Faxes may be sent to 206-774-3412. The Medical Billing department is generally staffed Monday to Friday from 6 am to 4:30 pm Pacific time.
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