KeratinPearls

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  • March 2010
    Feature Story
The professional component billing case, Martis v. Pekin Memorial Hospital, et al., ended in a win for pathology on Jan. 27 when the Illinois Supreme Court denied the petition for review.
Patient Richard Martis' lawsuit against Pekin (Ill.) Memorial Hospital, Data Management Inc., and Peoria-Tazewell Pathology Group concerned an October 2004 bill for laboratory tests: one from the hospital for $609 and one from the pathology group for $73.30. Martin contended in his lawsuit that the pathology group's charges amounted to illegal double billing.
The appellate court affirmed a trial court's dismissal of the case on Oct. 20, 2009. Martis petitioned a month later for review of the appellate court's decision.
Jack R. Bierig of the Chicago law firm Sidley Austin LLP represented the defendant pathology group in the trial and appellate courts. "I am delighted that the case has finally concluded with a complete victory for pathology," he told CAP TODAY. He was "honored" to have been able to represent the Peoria-Tazewell Pathology Group, he says, which "deserves the thanks and support of all pathologists who bill for the professional component of clinical pathology."
For the three messages the Martis ruling sends to pathologists who want to bill for the professional component, see "PC billing dishes victory&#8212;with a side of caveats," CAP TODAY, December 2009 (online at captodayonline.com).

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I was wondering if someone could tell me how this works? The patient thought he was being "double billed" for lab tests performed. He got a bill for 600 or so dollars from the hospital and 70 dollars from the path group. The path group gets paid a certain amount for the professional fee and the 600 is the technical component? LA can you chime in on this?
 

pathstudent

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Yes let's say a patient is an inpatient for a couple days and gets a few CBCs, 7-chems and a blood culture. The pathologists can charge a bit for being the one that oversees it all. It really isn't a TC/PC thing like AP which is more cut and dry. There really isn't a professional component when a machine figures out the hemoglobin. What the **** is there to interpret? It is more of a managerial fee.

That is one thing that I have heard is drying up. Private practice docs used to supplement their income with CP billing but insurance companies are now refusing to reimburse for it.

I can't say I blame them when it is all automated and run by techs who take care of all the qc and profiency. The pathologists really aren't involved with it all except signing protocol forms.



<TABLE class=copyBlack border=0 cellSpacing=0 cellPadding=0 width=795><TBODY><TR><TD width=536>
  • March 2010
    Feature Story
The professional component billing case, Martis v. Pekin Memorial Hospital, et al., ended in a win for pathology on Jan. 27 when the Illinois Supreme Court denied the petition for review.
Patient Richard Martis' lawsuit against Pekin (Ill.) Memorial Hospital, Data Management Inc., and Peoria-Tazewell Pathology Group concerned an October 2004 bill for laboratory tests: one from the hospital for $609 and one from the pathology group for $73.30. Martin contended in his lawsuit that the pathology group's charges amounted to illegal double billing.
The appellate court affirmed a trial court's dismissal of the case on Oct. 20, 2009. Martis petitioned a month later for review of the appellate court's decision.
Jack R. Bierig of the Chicago law firm Sidley Austin LLP represented the defendant pathology group in the trial and appellate courts. "I am delighted that the case has finally concluded with a complete victory for pathology," he told CAP TODAY. He was "honored" to have been able to represent the Peoria-Tazewell Pathology Group, he says, which "deserves the thanks and support of all pathologists who bill for the professional component of clinical pathology."
For the three messages the Martis ruling sends to pathologists who want to bill for the professional component, see "PC billing dishes victory&#8212;with a side of caveats," CAP TODAY, December 2009 (online at captodayonline.com).

</TD><TD vAlign=top width=11></TD></TR></TBODY></TABLE>

I was wondering if someone could tell me how this works? The patient thought he was being "double billed" for lab tests performed. He got a bill for 600 or so dollars from the hospital and 70 dollars from the path group. The path group gets paid a certain amount for the professional fee and the 600 is the technical component? LA can you chime in on this?
 

2121115

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True. There are only a few states left where you can bill PC for clinical pathology services and those states are fading fast.
 

SLUsagar

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True. There are only a few states left where you can bill PC for clinical pathology services and those states are fading fast.
path groups (private) often contract with the hospital to receive a set % and/or a set amount for the PC component for clinpath type services. It's fair, all in all. b/c when the **** hits the fan in the lab, you can be sure the path dept overseeing the lab has to deal with it. I can't tell you how many times even minor little things pathologists are involved in, from chatting with docs ordering inappropriate/wrong tests, to ensuring the INR reference range statements are correct based on clinical scenarios (# should be X-Y for a prosthetic heart valve, etc). Things like that don't necessarily show up as a unique bill each time we do these services, so a (mind you, VERY small) %/amount for global PC is ultimately, rather fair.
 

LADoc00

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Let me start by saying pathstudent is a blithering idiot. I hope to God you arent a pathologist, a pathologist in training or have any interest in actually being one..ever.

You have NO clue as to what a Pathologist does. And I refuse to spend my time explaining what value a Pathologist board certified in CP adds to lab tests and rightfully deserves to be compensated for.

This is tantamount to saying the CEO of GM deserves no compensation because he isnt on the assembly line actually building cars.

There are alot of newer very immature posters here on the Pathology forums. It makes me really sick tbh that some of these might one day be BC Path staff...somewhere.

Just glancing at this site is really making me regret starting to read and post here again and that is sad.

This used to be a place where people pleasantly exchanged info, war stories and opinions rather than off handed random crap that is prevelant now.

hasta
 
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LADoc00

Gen X, the last great generation
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True. There are only a few states left where you can bill PC for clinical pathology services and those states are fading fast.
No clue as to where you got this info, but it is utterly false. What the heck?!

Pathologists are RIGHTFULLY owed PC for lab tests. It IS compensated in every state in this flipping sad and dying Union.

Why would one roll into a lab, accept leadership, accept liability on YOUR MALPRACTICE insurance, spend hours of educational time with lab tech, attend budget meetings, negotiate for capital equipment, supervise regulatory events AND be on call 24-7 as required by LAW (!!) for NO INCOME? who? who the hell would do that?? no one you idiots!

Seriously, what is hell is up with the site?

Can someone start 1 single thread without white noise and gibberish?
 
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pathstudent

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Let me start by saying pathstudent is a blithering idiot. I hope to God you arent a pathologist, a pathologist in training or have any interest in actually being one..ever.

You have NO clue as to what a Pathologist does. And I refuse to spend my time explaining what value a Pathologist board certified in CP adds to lab tests and rightfully deserves to be compensated for.

This is tantamount to saying the CEO of GM deserves no compensation because he isnt on the assembly line actually building cars.

There are alot of newer very immature posters here on the Pathology forums. It makes me really sick tbh that some of these might one day be BC Path staff...somewhere.

Just glancing at this site is really making me regret starting to read and post here again and that is sad.

This used to be a place where people pleasantly exchanged info, war stories and opinions rather than off handed random crap that is prevelant now.

hasta
So how much do you bill for a cbc ordered at your hospital, if you are at a hospital?
 

Pingu

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So how much do you bill for a cbc ordered at your hospital, if you are at a hospital?
Not to answer for LADoc, but that kind of information is confidential, as is most if not all billing and insurance information.