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Industry Insights

Can a Physician Bill for Laboratory Services?

As you start to get your medical laboratory up and running, you may wonder, “Can a physician bill for laboratory services?” They are the ones providing the care, but can they take payment for your business’ hard work?

Read below to learn more about the process and find out the answer.


How the testing process works

When a physician needs specimen analysis, they will send it to a laboratory for tests. Afterward, the lab will send the results to the doctor, who can make important decisions regarding a patient’s care.

In most cases, the lab bills the patient’s insurance provider (payer) for the tests. However, a physician can bill for laboratory services if their location features a certified lab. Usually, these labs can conduct procedures such as blood count and urinalysis.


How the payment process usually works

The payment process is usually different when the physician uses an outside lab. The laboratory must decide the code for its test using the Current Procedural Terminology (CPT) code set. Meanwhile, the doctors must provide the lab with a code from the International Classifications of Diseases to categorize the patient’s illness.

The lab will send both codes in its bill to the insurance company, which will review and determine what it will cover and what it won’t. If there’s anything left that the provider won’t cover, the lab will bill that remaining sum to the patient.


How to ensure payments arrive on time

A major problem for collection departments can be late payments. When your lab is trying to get payments, your associates must do their best to ensure that the patient comprehends what they are paying for.


If you need assistance reviewing your current laboratory billing arrangement, our RCM Consulting Team is available to schedule a free consultation to help uncover deficiencies and optimize your collections. We work to ensure your billing is both efficient and compliant in order to maximize collections and minimize appeals and denials.


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