Doctors get paid for each lab test they run?

[MacGyver]

Ran into an old friend today. He tried to tell me that FPs have contracts with labs like Quest Diagnostics, where Quest pays the FP a fee everytime they send a lab test to them.

Is this right?

I was under the impression that docs generally dont get paid to run extra lab tests. Of course if you are the radiologist you get paid for every study, but the FP who ordered the imaging study doesnt get paid extra for the study, does he?

If this is true, it needs to stop. These kickbacks should be illegal.

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[spalatin]

Ran into an old friend today. He tried to tell me that FPs have contracts with labs like Quest Diagnostics, where Quest pays the FP a fee everytime they send a lab test to them.

Is this right?

I was under the impression that docs generally dont get paid to run extra lab tests. Of course if you are the radiologist you get paid for every study, but the FP who ordered the imaging study doesnt get paid extra for the study, does he?

If this is true, it needs to stop. These kickbacks should be illegal.

They are under the Stark and Stark II laws against self-referrals.


Of course residents who order extra tests on inpatients make money for the hospitals assuming of course the hospitals actually collect the lab fees from the payers.

 

[Dr. V]

I don't think that information is correct. It may be as I have limited experience but I rotated through several FP services and none of them had that.

Now many of them did get paid for lab fees, but that is because they made the investment and bought the lab equipment themselves and their office actually did the work.

The reason they did this is because insurance had cut their fees but tended to pay fairly well for lab tests so they bought the equipment to off set the fee cuts and try to keep the practice solvent.

Now it is my understanding that insurance companies are refusing to pay for labs run in house and cutting deals with Large Lab Incorporated to do all the labs for insurance company X. Large Lab Incorporated cuts the price due to bulk and therefore company X will only pay for labs done at Large Lab Incorporated.

Yet another way they are sqeezing the primary care docs.

 

[monkeyarms]

I don't think that information is correct. It may be as I have limited experience but I rotated through several FP services and none of them had that.

Now many of them did get paid for lab fees, but that is because they made the investment and bought the lab equipment themselves and their office actually did the work.

The reason they did this is because insurance had cut their fees but tended to pay fairly well for lab tests so they bought the equipment to off set the fee cuts and try to keep the practice solvent.

Now it is my understanding that insurance companies are refusing to pay for labs run in house and cutting deals with Large Lab Incorporated to do all the labs for insurance company X. Large Lab Incorporated cuts the price due to bulk and therefore company X will only pay for labs done at Large Lab Incorporated.

Yet another way they are sqeezing the primary care docs.

why all the nows? what about the thens?

 

[Dr. V]

Well if you must know,

The first one is just my speach pattern as in "now boys let me tell ya". I don't write formally on message boards. I leave the g of some ing ending words as well.

The second Now means presently as in what is going on right now in this time in our world.

What can I say, I'm just a hillbilly. You would croak if you actually heard me speak.

 

[Wrigleyville]

Ran into an old friend today. He tried to tell me that FPs have contracts with labs like Quest Diagnostics, where Quest pays the FP a fee everytime they send a lab test to them.

Is this right?

I was under the impression that docs generally dont get paid to run extra lab tests. Of course if you are the radiologist you get paid for every study, but the FP who ordered the imaging study doesnt get paid extra for the study, does he?

If this is true, it needs to stop. These kickbacks should be illegal.

I don't know about kickbacks to outside companies, but I'm pretty sure there is a gigantic loophole in the self-referral ban that allows the doctor to utilize diagnostic gear that is physically in their office. It's how some orthopod groups bilk the system with in-house MRI and X-Rays. They refer the patient to their own MRI, collect the "technical" portion of the fee by owning the gear and the "professional" portion of the fee by interpreting the study.

 

[Sugar72]

The last FP office I rotated in had just changes their billing statement form due to pressure from insurance companies. They can bill the patients insurance company more if they order a lab test regardless of the lab they use. in other words....diabetic check wasn't good enough....they needed to have diabetic check with blood work drawn. I don't know if he got any kind of kickback from labcorp or quest - both of which he used.

 

[kbrown]

The last FP office I rotated in had just changes their billing statement form due to pressure from insurance companies. They can bill the patients insurance company more if they order a lab test regardless of the lab they use. in other words....diabetic check wasn't good enough....they needed to have diabetic check with blood work drawn. I don't know if he got any kind of kickback from labcorp or quest - both of which he used.

this example sounds more like 'coding' than 'kickbacks'. i know that coders are trained to look through charts for key words. if they do not see those words you will not get paid for the service. for example: they don't want to see under diagnosis (an arrow up) and the word -kalemia to follow for hyperkalemia, they are not allowed/permitted to infer that you mean hyperkalemia. thus, you will not be paid, or the hospital will not be paid for that diagnosis/workup.

 

[Dunce]

this example sounds more like 'coding' than 'kickbacks'. i know that coders are trained to look through charts for key words. if they do not see those words you will not get paid for the service. for example: they don't want to see under diagnosis (an arrow up) and the word -kalemia to follow for hyperkalemia, they are not allowed/permitted to infer that you mean hyperkalemia. thus, you will not be paid, or the hospital will not be paid for that diagnosis/workup.

I f-ing hate insurance companies and their *****ic practices.

Sorry to take up space. I just needed to vent that

 

[NewIMdoc]

The last FP office I rotated in had just changes their billing statement form due to pressure from insurance companies. They can bill the patients insurance company more if they order a lab test regardless of the lab they use. in other words....diabetic check wasn't good enough....they needed to have diabetic check with blood work drawn. I don't know if he got any kind of kickback from labcorp or quest - both of which he used.

I could be wrong on this, but the change may be in response to some of the Performance based measures type stuff going on (I'm not sure that is the right term), but the idea is that if someone is having a diabetic checkup, they need Heme AIC ordered, so that without it, the checkup might not have been considered complete-- there is talk about reimbursing docs who are doing better on these measures more. I don't know details, so this is speculation.

 

[Sugar72]

I could be wrong on this, but the change may be in response to some of the Performance based measures type stuff going on (I'm not sure that is the right term), but the idea is that if someone is having a diabetic checkup, they need Heme AIC ordered, so that without it, the checkup might not have been considered complete-- there is talk about reimbursing docs who are doing better on these measures more. I don't know details, so this is speculation.

I think that is right. He was doing the appropriate blood tests at the appropriate time but it wasn't being coded with the lab work so yeah it is a bunch of pain in the bootie hoop jumping for insurance companies. There was no kickback involved that I heard about.

 

[spalatin]

I don't think that information is correct. It may be as I have limited experience but I rotated through several FP services and none of them had that.

Now many of them did get paid for lab fees, but that is because they made the investment and bought the lab equipment themselves and their office actually did the work.

The reason they did this is because insurance had cut their fees but tended to pay fairly well for lab tests so they bought the equipment to off set the fee cuts and try to keep the practice solvent.

Now it is my understanding that insurance companies are refusing to pay for labs run in house and cutting deals with Large Lab Incorporated to do all the labs for insurance company X. Large Lab Incorporated cuts the price due to bulk and therefore company X will only pay for labs done at Large Lab Incorporated.

Yet another way they are sqeezing the primary care docs.

Docs can bill and be paid for lab work they do themselves. This is true. It's fairly easy to set up a very small lab to do gram stains, HCTs and basic chemistries. This is very different from the labs sending compensation to referring physicians, ie the primary doc who orders a lab test and sends it to an outside lab. This can be billed. A doc can also have an x-ray set in his office and take x-rays, too and bill for those. I personally wouldn't want the liability of taking a chest xray and missing a nodule when I was looking for pneumonia, but some are willing to take the risk.

And you are also correct that the insurance companies are refusing to pay for these tests from the primaries favoring bulk contracts with select labs. Ever wonder why insurance companies don't just build their own labs, radiology suites and hire docs directly, squeeze them dry and we all go to work for Micky D's on the side just to get health insurance? Scary!