In reply to Jeff Silverman about referrals to other instutitions.  We do
not charge--for one thing I can only make a charge attached to a CPT code.
I don't think that there is a CPT code for this procedure because it would
also have to have a diagnosis.  Yes I know that there is a diagnosis for
all of these send outs but it would be different for each send out.  I know
that many medical records departments have charges that cover copying
records, postage, etc. so I don't know why we couldn't charge for our
referral handling.  The down side is that the patient would be entirely
responsible for the charge, even if they had insurance.  I think that it
can average me 20 minutes from start to finish when I have to pull slides,
record where they are going, make sure I have the correct slides the
patient is looking for, copy the path report and any other tests that might
have a bearing on this case.  Pack it all up so that it would be damaged in
shipping and make an address label.  That can add up in a lab and you have
no revenue for this time.

I know that I didn't come to a conclusion Jeff, but maybe others will add
to this.  Priscilla in Central Wyoming