RE: Medicare Billing

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From:"D. Hammer" <> (by way of histonet)
To:histonet <>
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In a perfect world, the consulting pathologist will get permission from
the refering institution to run additional special or immunos.  As a
matter of fact,the consultant needs to have a record of the order from
your institution in order to be "legal" in their billing. (if they bill
insurance companies)

We have the same problem here, but more so, we are remiss in getting the
permission from the refering institution and giving them info to bill
with.  We do alot of direct insurance billing as opposed to billing the
institution, but that will change with the Medicare patients.  We are
working on the staff getting permission to run additionaals.

Don't you think, as I do, that NSH should have Dennis Padget (Padget
Associates) give a half or all day workshop on Pathology billing.  People
would be amazed at how complex it is and how many things are not done
correctly.  My god, there are still people billing for slides and/or


Don Hammer, Administrative Director            UNIVERSITY OF WASHINGTON
Hospital Pathology, Box 356100                     MEDICAL CENTER
1995 NE Pacific St.
Seattle Washington, 98195                  ~Where Knowledge Comes To Life~
(206) 548-6401 Fax: (206) 548-4928

On Tue, 24 Nov 1998, Weems, Joyce wrote:

> Hi Margarie and all!
> I have been mulling over this billing thing for over a year and am still
> confused!!! I have asked our legal department about it and they are
> confused!!!
> Our biggest problem has been with consults, which is what I am trying to
> change. If we send out consults and bill the patient from our
> institution, we often incur more charges when the consulting pathologist
> does additional  special stains or immunos. We then can not collect
> those charges, because it has been too long past the date of service.
> Now, granted, the biggest problem is with Medicare, (our census is ~65%
> Medicare!), but insurance companies are also beginning investigations so
> that everything is under scrutiny. The problem is that Medicare charges
> FRAUD instead of error!
> I am looking forward to what answers we are going to come with!
> Joyce
> >----------
> >From: 	Hagerty, Marjorie A.[]
> >Sent: 	Monday, November 23, 1998 8:18 PM
> >To: 	Histonet
> >Subject: 	Medicare Billing
> >
> >
> >Hi Everyone,
> >
> >After reading Joyce Weem's explanation concerning medicare billing
> >requirements, I find myself very confused. I am, however, less confused
> >I was before I read it! I am beginning to think that I am making some
> >illegal billing decisions. (Oh, no!)
> >
> >My question is this - Where can I find out more information on this? What
> >can I read?
> >Is anyone willing to explain this to me in a phone conversation? Joyce? Any
> >billing experts?
> >
> >All help and direction will be greatly appreciated. I don't want all
> >reference laboratories to bill us because I know we will lose money. I
> >like to have the reference laboratory bill whenever it is legal.
> >
> >Marg
> >Rancho Mirage, CA, USA
> >
> >
> >

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