Many smaller nonpathology practices (especially urology, gastroenterology, and dermatology) employ or contract with a pathologist or pathology practice to provide professional interpretation services (the professional component [PC]), while the technical component (TC) is performed and billed by an independent off-site pathology laboratory.
This TC/PC arrangement can be acceptable, but only under the right circumstances, according to Ms. Wood, whose practice of law focuses on protecting pathologists' rights.
"I have clients being pressed into these arrangements," she said, "where the provider basically says, 'You do the interpretations in our office on our behalf so that we can bill the patients and pay you significantly less."
Some of these arrangements are not operating within the confines of the law, often because the TC/PC laboratory sales representatives "are not telling them the legal ramifications," Ms. Wood explained.
She has observed aggressive marketing of TC/PC arrangements by TC laboratories and promises of unrealistic profits. "One of my clients was offered $17 per interpretation," she said. "The TC lab had told the referring physicians that this is all they would need to pay the pathologist and they were thrilled to go forward."
However, discounted account billing is not acceptable. Under the Anti-Markup Rule, the practice cannot bill Medicare more than it pays its pathologist. "If the practice is not in compliance and it bills Medicare more than it should, the pathologist can also be held responsible because he or she reassigned the right to bill," she said.
She added that some states are now requiring direct billing by the pathologist to guard against these "mark-ups." In Massachusetts, Blue Cross Blue Shield will not pay for "pass-through" billing.
