Ordering labs with Medicare - Jan 2013

Ordering labs for Medicare pt

Dr Bye

Message 1 of 9 , Jan 2, 2013[-- Image: Frame1 --]



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I just got a e mail from my local lab. They just switched
insurance billing companies. They have informed the lab I have
used for over 10 years that as a ND I can not order labs for my
medicare pt as ND's are not recognized by the Federal medicare
program? Has anyone else run into this. I
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Kristin Cox

Message 2 of 9 , Jan 2, 2013[-- Image: Frame2 --]



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When I recently talked to the Medicare information office in
Juneau,
they said they don't care who the prescribing physician is as
long as
the lab is certified. I have avoided ordering for medicare
patients
anyway but according to her, it should work. On an associated
note,
DirectLabs which is a subsidiary of LabCorps has wicked cheap
prices,
even cheaper than Meridian Valley. If I'm concerned that
insurance
isn't going to cover the lab bill, I use this lab (which is just
LabCorps, wearing a different hat). Phone number is
800-908-0000. Or
online at directlabs.com.

Kristin Cox
Juneau, AK

James Mullane, ND

Message 3 of 9 , Jan 2, 2013[-- Image: Frame3 --]



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Dear Dr. Bye (you didn't sign your name or where you practice
so...)



I ran into this in November with Quest here in CT. They too have
claimed that they are being required to comply to insurance
regulations and that they can not bill Medicare on behalf of
NDs or DCs. They are claiming that it is illegal for NDs and
DCs to bill medicare/order labs on Medicare patients and as
such Quest can not do so on their behalf. They also claim that
they have never billed Medicare on behalf of NDs and DCs
instead they wrote off the bills as loss instead of going after
the 2nd insurance or going after the patient. Further they claim
since its illegal to file medicare that its also illegal to bill
the patient's 2nd insurance company. Instead Quest is
backbilling all their ND and DC clients for past balances due.
The woman at Quest was very insistent that Quest notified me of
this last spring (I have never received the letter she claims
was sent and I have now subsequently requested said letter 3
times and have yet to receive it) and that it is my failure and
failure of my education not to know that its illegal to
bill/order labs for Medicare Patients.



So, I then called my patient's 2nd Insurance Company (Cigna) and
was told that they would cover the labs per the patient's plan.
According to the woman there, I would have to pay Quest and get
a copy of the paid bill. I would then submit the paid bill plus
the letter (the famous elusive letter) to Cigna and they would
re-imburse me. Its a lot of paperwork for this one patient but
in the future I will not order labs for my Medicare patients,
but refer them back to their PCP's.



Hope that helps.



Jim

James Mullane, ND

Natural Family Medicine

72 North Street, Suite 100A

Danbury, CT 06810

203-942-4797

Mona Morstein

Message 4 of 9 , Jan 2, 2013[-- Image: Frame4 --]



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It was made quite clear here in Arizona that Quest would never
allow NDs to do labs on patients who have Medicare and I think
that makes sense. We aren't covered by Medicare. Now, Labcorp
will allow us to do labs on Medicare patients IF they have a
supplement; when Medicare rejects the labs they file through
the supplement. That works out great. But, if the patient does
not have a supplement, I cannot use Labcorp either and have to
send the patients back to their pcp with requests certain labs
are done.

Mona Morstein, ND
Mesa, AZ

c bye

Message 5 of 9 , Jan 2, 2013[-- Image: Frame5 --]



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James, thanks for the notice, sorry about the sig. It was set up
to do that automatically on my Blackberry.

So in your scenario, you can order the tests but inform the
Medicare pt that they have to use their secondary insurance? Or
does it have to be denied first and then make for a lot of extra
paperwork for everyone, and more time and visits for the patient
and the Pcp. just a bunch of redundancy for an already over
burdened system? I hate sending them back to pcp as most don't
understand why I order what I do.
For the state associations, is there any way to circumvent this,
or facilitate a system to avoid this? Perhaps we should partner
with the DCs to make this easier for all involved?

Cynthia Bye, ND
Vancouver, Wa

James Mullane, ND

Message 6 of 9 , Jan 2, 2013[-- Image: Frame6 --]



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Hi Cynthia.

In my case/scenario..I can order the labs, but it has to be done
as physician bill with Quest never knowing patient has
Medicare..then supposedly (according to Cigna) I can then
submit the paid bill (I am required to pay the bill) with the
letter saying Quest is unable to submit bill to Medicare to
Cigna for re-imbursement. I am a cash only practice so playing
with insurance is a headache. For this one patient I will do
it, but in the future will send patient back to PCP for
bloodwork.

I will check out labcorp and see what they do.

Jim

James Mullane, ND
Danbury, CT

Dr. James Mullane
Natural Family Medicine
72 North Street, Suite 100A
Danbury, CT 06810

c bye

Message 7 of 9 , Jan 2, 2013[-- Image: Frame7 --]



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Got it, I will be consulting with the lab rep the second week of
jan. and let you know what I find out. In the mean time hope to
hear something from state associations.

Cynthia Bye, ND
Vancouver WA

Loretta Osik

Message 8 of 9 , Jan 2, 2013[-- Image: Frame8 --]



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Hi:   I was just notified by Quest that NDs and Chiros cannot
order labwork for medicare pts. As we know because it is
Federal, we are excluded.  In the past when I submitted for
visit coverage a special form needs to be filled out for
Medicare stating that I was a nonpar provider and then the
claim could be submitted to the secondary ins.



Have a Happy New Year.



Loretta Osik,ND

Danbury, Ct.

Karen Jones

Message 9 of 9 , Jan 3, 2013[-- Image: Frame9 --]



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You can order labs for Medicare patients in OR if you have the
lab bill the patient AND the patient sign an ABN.

Karen jones, ND
Salem or

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