Indiana direct billing law

[WEBB PINKERTON]

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Direct billing for anatomic pathology specimens goes into effect July 1st in Indiana. I was suprised how few people know about this law from conversations I have been having with other labs. Hopefully I wont have physicians ask me to lower my client pricing anymore. Probably have to give the offices Gander Mountain gift cards or something to make up the difference.

http://e-lobbyist.com/gaits/IN/HB1071

 

[Unty]

Direct billing for anatomic pathology specimens goes into effect July 1st in Indiana. I was suprised how few people know about this law from conversations I have been having with other labs. Hopefully I wont have physicians ask me to lower my client pricing anymore. Probably have to give the offices Gander Mountain gift cards or something to make up the difference.

http://e-lobbyist.com/gaits/IN/HB1071

Can you tell me what this all means?

 

[redapple123]

Direct billing for anatomic pathology specimens goes into effect July 1st in Indiana. I was suprised how few people know about this law from conversations I have been having with other labs. Hopefully I wont have physicians ask me to lower my client pricing anymore. Probably have to give the offices Gander Mountain gift cards or something to make up the difference.

http://e-lobbyist.com/gaits/IN/HB1071

is it good news or bad news?

 

[WEBB PINKERTON]

Good news. No more client billing, fee spliting and all that BS anymore. Hopefully the law will be enforced. We informed offices of the change a month ago. They were disappointed but oh well. They will have to learn to live without that revenue.

 

[Entgegen]

Good news. No more client billing, fee spliting and all that BS anymore. Hopefully the law will be enforced. We informed offices of the change a month ago. They were disappointed but oh well. They will have to learn to live without that revenue.

That's great. From your posts I'm assuming you practice in Indiana. Do you know if this law pushed by pathologists lobbying for it, or was it through some other healthcare cost-control measures, or what? Any tips on how other states can get similar laws on their books?

 

[WEBB PINKERTON]

That's great. From your posts I'm assuming you practice in Indiana. Do you know if this law pushed by pathologists lobbying for it, or was it through some other healthcare cost-control measures, or what? Any tips on how other states can get similar laws on their books?

Indiana State pathology society working with ASCP got it through. Tried a few years ago to get this same bill passed but it died. I am glad we didnt get screwed at the last minute like Ohio. In Ohio an exception was made for derm specimens. So there are still some sweatshop dermpath labs there doing skins for very low client prices. CAP Today once had an article about an Ohio Derm sweatshop that had high pathologist turnover because of the stress. If we dont get rid of kickbacks, ALL labs will be reckless factories since profit margins are getting so small.

Work with your state societies. Get ASCP involved. We gotta try to get as many victories as we can.

 

[pathstudent]

So this bill prevents a clinician from sending a specimen to a another lab and paying the lab X and then having the same physician bill insurance/patient y?

Does it do anything to stop urologists and gastros from hiring pathologists and paying them a dime on the dollar? It doesn't sound like it does or can.

Still it is good that it was made into law.

 

[WEBB PINKERTON]

So this bill prevents a clinician from sending a specimen to a another lab and paying the lab X and then having the same physician bill insurance/patient y?

Does it do anything to stop urologists and gastros from hiring pathologists and paying them a dime on the dollar? It doesn't sound like it does or can.

Still it is good that it was made into law.

It only stops "client billing". Now the lab must directly bill the patient. It does nothing to prevent urologists and gastros from hiring pathologists and paying them dime on the dollar though. I honestly think that arrangement is here to stay unfortunantly.

I am gonna be curious to see what effect this new law has here in Indiana. Will physicians quit ordering so many tests now that they can't do client billing? Time will tell. We got many phone calls from concerned physicians after we told them about the new law. They just lost a lot of revenue. Hope they dont want me to give them Gander Mountain gift cards or something.

 

[pathstudent]

It only stops "client billing". Now the lab must directly bill the patient. It does nothing to prevent urologists and gastros from hiring pathologists and paying them dime on the dollar though. I honestly think that arrangement is here to stay unfortunantly.

I am gonna be curious to see what effect this new law has here in Indiana. Will physicians quit ordering so many tests now that they can't do client billing? Time will tell. We got many phone calls from concerned physicians after we told them about the new law. They just lost a lot of revenue. Hope they dont want me to give them Gander Mountain gift cards or something.

Excuse me for being a bit thick-headed about this. I am not part of that rough and tumble world, but I want to understand it.

Does Client Billing mean the pathologist bills the urologist and then the urologist bills the patient/insurance for the pathology?

What is more prevalent Pod labs or Client Billing?

YOu are right there is no way to end Pod Labs. You could never pass a law that says a physician can't employ another physician and bill for their work. It goes on all the time, including in pathology practices.

 

[WEBB PINKERTON]

Excuse me for being a bit thick-headed about this. I am not part of that rough and tumble world, but I want to understand it.

Does Client Billing mean the pathologist bills the urologist and then the urologist bills the patient/insurance for the pathology?

What is more prevalent Pod labs or Client Billing?

YOu are right there is no way to end Pod Labs. You could never pass a law that says a physician can't employ another physician and bill for their work. It goes on all the time, including in pathology practices.

Yea, client billing is where the lab bills the physician and then the physician bills the patient/insurance. Due to economy of scale labcorp, quest and other sweatshops can come in and take all your accounts since they can offer such low client pricing. They get their supplies significantly cheaper and they force so much productivity.

Saddest day of my professional life was sitting at a table with an OBGYN account we had lost. The doctors said they loved the quality of my lab's work but wanted me to lower my client pricing on a certain AP test by 1 f**king dollar. Never have I felt so small and that day made me realize I was in the wrong business.

 

[pathstudent]

Yea, client billing is where the lab bills the physician and then the physician bills the patient/insurance. Due to economy of scale labcorp, quest and other sweatshops can come in and take all your accounts since they can offer such low client pricing. They get their supplies significantly cheaper and they force so much productivity.

Saddest day of my professional life was sitting at a table with an OBGYN account we had lost. The doctors said they loved the quality of my lab's work but wanted me to lower my client pricing on a certain AP test by 1 f**king dollar. Never have I felt so small and that day made me realize I was in the wrong business.

Well that is great. So this basically levels the playing field between small groups and the huge labs and additionally prevents office docs from making money off pathology services.

 

[scienceguy19]

It just upsets me that we allow urologists and gastroenterologistss to push us around and take advantage of us. It's too bad there are too many pathologists, so they can do as they please, unless we get legislation passed (which is a hurdle in itself and takes years of lobbying). Lawmakers are slow to act as well.

 

[pathstudent]

It just upsets me that we allow urologists and gastroenterologistss to push us around and take advantage of us. .

I feel the same but I don't think there is any way you could pass a law and say one physician can't hire another physician and treat him like his bitch. Heck that is what happens in private practice groups all the time. Senior pathologists hire junior pathologists and pay them nickels on the dollar.

Lastly, some pathologists might enjoy these jobs and not care that the urologist is making more off the path than the pathologist is. They might like the fact that signing out GI and Prostate biopsies is in general as easy as it gets, that there is no call, that there are no frozens, no CP BS to put up with, no tumor boards, that the days are short and overall it is easy money.

 

[yaah]

I feel the same but I don't think there is any way you could pass a law and say one physician can't hire another physician and treat him like his bitch. Heck that is what happens in private practice groups all the time. Senior pathologists hire junior pathologists and pay them nickels on the dollar.

Lastly, some pathologists might enjoy these jobs and not care that the urologist is making more off the path than the pathologist is. They might like the fact that signing out GI and Prostate biopsies is in general as easy as it gets, that there is no call, that there are no frozens, no CP BS to put up with, no tumor boards, that the days are short and overall it is easy money.

It also happens with hospital employees, including other specialties as well. It would be hard to write such a law to specifically target pod labs for this.

 

[WEBB PINKERTON]

I just hope POD labs kill off the Labcorp, Quest, Bioreference labs, Ameripath and Bostwicks of the world. I'd actually prefer to work for a POD lab than those places.

We will see if the playing field is leveled in my state. I wonder if the law is gonna be enforced very well. Heck California had a law that medi-cal patients should get the lowest rate and it wasnt enforced for years. Labcorp, quest and westcliff openly violated the law for a long time.

 

[scienceguy19]

Yeah I think Labcorp, quest, and other corporations are worse. I mean, the CEO of labcorp is a freaking lawyer. I guess suing doctors wasn't enough fun for him, and he had to be our slave owner instead. And not to mention other members of the executive board who are MBAs and drank their way through business school.

I just hope POD labs kill off the Labcorp, Quest, Bioreference labs, Ameripath and Bostwicks of the world. I'd actually prefer to work for a POD lab than those places.

We will see if the playing field is leveled in my state. I wonder if the law is gonna be enforced very well. Heck California had a law that medi-cal patients should get the lowest rate and it wasnt enforced for years. Labcorp, quest and westcliff openly violated the law for a long time.

 

[zao275]

Work with your state societies. Get ASCP involved. We gotta try to get as many victories as we can.

Amen. Work with state societies, ASCP, CAP, all of the organizations. If your state society is dead, help to resurrect it.

We should do our part to make things better, and then we will have earned the right to complain!

 

[WEBB PINKERTON]

http://www.ismanet.org/news/ViewArticle.aspx?ArticleId=359

Looks like their is some confusion right now about the new law. I got his email yesterday.

 

[KCShaw]

It -should- be very simple. A physician cannot profit from "ordering" a laboratory test. The end. It's the basic concept against self-referral, although there is a more collegial attitude towards it when talking about physician groups -- a family practitioner refers to a dermatologist or general surgeon or endocrinologist, etc., within the same profit-sharing practice, so technically it should be a form of self referral, but much of the time there is a more tangible benefit to everyone in the group, even if it's not all financial, and everyone has a reasonable choice to set up practice on their own instead and expect survivable income. In pathology it doesn't work out that way, in part because there's no reverse referral so the only thing pathology can "give" back is income in exchange for volume -- there's not much else to gain except volume, unless it's practice management in some GI/uro/etc. office, so down into the spiral of more work for less pay we go.