Can a hospital hired Pathologist bill for or be reimbursed for the PC?

[Manek777]

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Hello everyone:

Could I please have your thoughts/input regarding this manner?

Can a hospital hired pathologist bill for or be reimbursed for the Professional Component?

- I am currently a hospital hired pathologist with a fixed salary and other benefits (health, 401, etc.).
- I am currently in a position to heavily negotiate my contract (for many reasons to list here).
- My question is that can I bill separately for the Professional Component while still being employed by the hospital(the hospital will bill separately for Technical component)? Or is it against the law to do so (meaning would I have to be a independent contractor to do so)?
- Or is it legal to ask the hospital to do "Global Billing" and then ask them to cut me check for the professional component portion?​

Your advise is much appreciated.

 

[Path or bust]

Since you are a hospital employee, they are likely billing the PC and TC. They likely will not cut you a check for PC portion, not because it would be a kickback (as you don't provide any referred patients) but you probably could negotiate a higher salary.

 

[LADoc00]

Hello everyone:

Could I please have your thoughts/input regarding this manner?

Can a hospital hired pathologist bill for or be reimbursed for the Professional Component?

- I am currently a hospital hired pathologist with a fixed salary and other benefits (health, 401, etc.).
- I am currently in a position to heavily negotiate my contract (for many reasons to list here).
- My question is that can I bill separately for the Professional Component while still being employed by the hospital(the hospital will bill separately for Technical component)? Or is it against the law to do so (meaning would I have to be a independent contractor to do so)?
- Or is it legal to ask the hospital to do "Global Billing" and then ask them to cut me check for the professional component portion?​

Your advise is much appreciated.

You need to have someone CAREFULLY review your contract.

Are you alone? What is your deal as this is kinda of a strange request. People usually well know they can or cant bill.

 

[AZpath]

It is not against the law as far as I know.....
However:
You generally assign billing to your employer so they can cover your salary and benefits by billing MC and third parties. No matter what you cannot be sending two bills for the same service.
In theory, they could pay you some kind of salary for being medical director and you bill as a IC for the anatomic pathology PC.
This is pretty unusual.

There are an number of common legal structures available for pathology services.
If you really don't want to mess with business then being an employee with a good salary is fine.

But first:
Do you know how much the hospital collects for pathology codes?
Do they have good contracts so they can pay you the best salary?
Do they share that information with you?
What does MC and commercial insurance pay in your area?

The best solution may be to have a productivity bonus. You will need to educate yourself to these issues no matter what!!

If you are going to bill yourself these issues are even more important.
Getting a good contract with commercial insurance is getting very tough.
I don’t recommend doing this by yourself these days. You need a consultant to get started. Not just a biller.
Vachette Pathology or someone else .

Remember it will take at least 4-5 months to be credentialed as new independent entity. So you might not see any cash for 5-8 months. Also realize that next year collections will be perhaps 10-15% lower due the PC cuts depending on your IHC Volume.

Salaries can insulate you quite a bit when revenues are falling.

Most hospital will try to offer 50-75% of MGMA for reimbursement for salary. Hospitals are afraid to offer much over 75% as compensation for compliance reasons. MGMA has different scales for medical directors.

Good Luck the ball is in you court!

 

[Thrombus]

I would go to admin and tell them you expect to start billing yourself this year like the professional that the CAP says you are. Tell admin their is a looming shortage and show them the latest Archives article. If this is true, admin will do whatever it takes to keep you happy as they will not want to be without a pathologist!

 

[icpshootyz]

You'd probably have to get an entirely new contract and you'd have to get the hospital to be willing to give up global billing and allow you to have the PC while they take cuts in the TC. My guess is pigs will be flying before that happens for you, unfortunately. They'd likely be able to find a different pathologist who would take your salary as is and not expect any more. Sadly.