WPM PATHOLOGY LABORATORY BILLING

IN-HOUSE BILLING

The in-house Billing Department at WPM Pathology Laboratory provides four options for billing:

  1. Client billing (physician/clinic/hospital)
  2. Direct patient billing
  3. Third party (Medicaid, Medicare, and commercial insurance) billing
  4. Referral lab billing (specialized testing not performed at WPM and billed by the lab performing the test. Mayo Medical Laboratory will only bill Medicare and no other insurance plans.)

CLIENT BILLING

Client billing is done at the first of the each month. An itemized statement for all testing done during the previous month is issued.

Statements include the following information:

  1. Date of service
  2. CPT code
  3. Description
  4. Patient name
  5. Accession number
  6. Charge

Please note, that as a participating provider, WPM Pathology Laboratory must third party bill all surgical pathology and cytology services payable by Medicaid, Medicare, and Blue Cross/Blue Shield. WPM routinely bills all surgical pathology services.

DIRECT PATIENT BILLING

Upon the client’s request, WPM Pathology Laboratory will bill the patient directly. The patient will receive an itemized statement. The patient may then file an insurance claim, or may return a copy of an insurance identification card to WPM Pathology Laboratory to be filed for benefits. Please make sure that WPM Pathology Laboratory is provided with the responsible party name, mailing address, date of birth, and diagnosis code/codes.

Please note, that as a participating provider, WPM Pathology Laboratory must third party bill all surgical pathology and cytology services payable by Medicaid, Medicare, and Blue Cross/Blue Shield. WPM routinely bills all surgical pathology services.

THIRD PARTY BILLING

WPM Pathology Laboratory is a participating provider of Medicare, Kansas Medicaid, and Blue Cross/Blue Shield of Kansas and must bill directly for all surgical pathology and cytology services performed in our laboratory. WPM Pathology Laboratory will also bill other third party payers, as per the agreement with the client.

WPM Pathology Laboratory must have all pertinent information:

  1. Medicare, Medicaid, or insurance identification number
  2. Responsible party name
  3. Mailing address
  4. Date of birth
  5. Diagnosis code(s)
  6. Insurance company name and billing address

A copy of the patient's insurance card attached to the test request form is a convenient way to provide this information.

REFERRAL LAB BILLING

There may be special cases, such as flow cytometry studies, in which WPM Pathology Laboratory refers out to another laboratory. In some of these cases, the lab doing the actual testing may bill for the service. WPM Pathology Laboratory will provide the testing laboratory with the necessary billing information provided by the client.

ICD-9/CPT CODES

Medicare, Medicaid, and most third-party payers are now requiring a written diagnosis or diagnosis code per the ICD-9 terminology before payment can be made. It is the responsibility of the client to determine the correct ICD-9 code to use for billing.

Some testing, such as Pap smears will not be paid in concurrent years unless the patient has a medical diagnosis supporting the testing.

WPM Pathology Laboratory uses the CPT coding procedures as prescribed by the American Medical Association (AMA) and recognized by most third-party payers.

HMO REFERRALS

Some tests, such as HPV, Chlamydia, and GC, require specific referrals from HMO Primary Care Physicians (PCP). All pathology and cytology services for HMO patients should be scrutinized to determine if specific PCP referral is required. Please check with HMOs to insure that proper steps are taken to insure authorization of tests ordered. WPM Pathology Laboratory will double check to make sure that referrals are included with test requests for HMO patients, but it is ultimately the responsibility of the ordering physician to secure a proper referral from the PCP.

PAP SMEAR BILLING

Medicare will only pay for a screening Pap smear every two years (unless the patient qualifies for a more frequently performed screening pap smear). If there is any question as to whether the patient has had a Pap smear within that time frame, the patient must sign the Advance Beneficiary Notice (ABN) on the back of the WPM Pathology Laboratory GYN CYTOLOGY requisition form. This will save the client, the patient, and WPM Pathology Laboratory a great deal of time and effort.

SPECIAL BILLING REQUESTS

From time to time special cases arise in which the patient does not want to be billed or contacted at home, or have a claim filed with their insurance carrier. WPM Pathology Laboratory will honor such requests, provided that we are notified by the client of the need for such an arrangement. In these cases it must be clearly noted on the test request form. “Confidential. Client Bill Only.” should be printed in large red lettering in the area of the form designated for insurance information. When this request is made billing will be sent to the client, and will not be filed with the patient's insurance even if third party billing is the usual arrangement. No correspondence will be sent from WPM to the patient.

contact us

  • WPM Pathology Laboratory
  • 338 N. Front St.
  • Salina, KS 67401
  • 785.823.7201