New post from pathologist medscape blog (TC open to the highest bidder)

[WEBB PINKERTON]

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Members don't see this ad.

Just when you think you have seen it all. 🙂

Anyone else seeing this?

 

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Just when you think you have seen it all. 🙂

Anyone else seeing this?

http://boards.medscape.com/forums?128@@.2a58a8ca!comment=1

Can you cut and paste. The link requires registration to read it.

 

[WEBB PINKERTON]

Can you cut and paste. The link requires registration to read it.

Registration is free for that website. Medscape is a very nice resource. Good articles there and some blogs. The comments at the bottom of the blogs sound the same as what you hear on this forum. SDN is hardly the only forum with upset pathologists. Remember students considering pathology, where there is smoke there is fire.

Here is that blog entry.


Technical Component – Open to the Highest Bidder
Thomas Wheeler, MD, Pathology, 06:03PM Jul 5, 2013


A new twist has emerged in the physician-owned anatomic pathology laboratory market. Perhaps it was sparked by the 52% reduction by CMS for the technical component (TC) of the 88305 (most common biopsy CPT code) at the first of the year. The TC reimbursement went from $69.78 to $33.70 on January 1st. Old news, right? Wrong.

From what I understand (and have witnessed at least once) a new model is emerging for these laboratories - instead of billing the TC (either isolated or part of a global charge) directly to the government or third party payers, these laboratories have begun marketing their TC to the pathology group that will pay the most for it. In some cases this has been reported to be in the $80-$90 range. The attorneys that I have seen opine on this say at best this practice is questionable and at worst an illegal inducement to do business. In theory one could not pay for the TC above fair market value in order not to be considered an inducement. But what is fair market value in this case? Is it what CMS was paying in 2012 or 2013? Is it based on what the market dictates, after all it is fair market value? Is the market price based upon the cost to do the service or what the market will bear? I suspect my lawyer friends would say the former. One way to know for sure is to write the Office of Inspector General (OIG) concerning a hypothetical or real life situation and ask for an advisory opinion. Some have done this for their own planned business practice or (more commonly) to assess the legality of the activities of other labs that seem to be inappropriate/illegal.

I am interested to know how widespread this practice is becoming and would welcome your responses. Also, please vote in the attached poll

 

[icpshootyz]

I'm confused. What is costing $80-90, the TC component of billing? That makes no sense when the combined PC/TC reimbursement is only around $70. Am I missing something here?

 

[WEBB PINKERTON]

I'm confused. What is costing $80-90, the TC component of billing? That makes no sense when the combined PC/TC reimbursement is only around $70. Am I missing something here?

Hopefully he will explain it further when the pathologists start posting comments on there. Must be a lot of pull through business that makes it possible to pay 80-90 for the TC. Considering how competitive it has become to get specimens, NOTHING shocks me anymore.