Billing

A variety of billing options is available through the Outreach Services program. MMCI can set up a client account and bill services back to the physician office. Statements will be sent monthly to each account. Payment is expected within 30 days of statement for each account.

Methodist will also bill Medicare, Medicaid, other third party payors, or the patient directly. Billing to third party payors or Medicare and Medicaid requires complete patient demographic and billing information as well as diagnostic information in ICD-9 Format. If proper patient information is not provided, Methodist will bill the client account directly.

Medicare Coverage of Laboratory Testing

There have been a number of recent changes in the payment policies of the Medicare program. Under the new policy:

1. The ordering physician must list a diagnosis with an ICD-9 diagnosis code in order to indicate the medical necessity of a test.
2. Each individual test component of an automated chemistry panel must be medically necessary in order to qualify for reimbursement.  However, as a general rule, standard disease or organ panels as defined by the Physicians’ Current Procedural Terminology (CPT) (i.e. 80055-90092) is considered an individual test.
3. Medicare may not pay for non-FDA approved tests or for screening tests.
4. If there is reason to believe that Medicare will not pay for a test, the patient should be informed of that fact. The patient should then sign an Advance Beneficiary Notice, or ABN, to indicate that he or she is responsible for the cost of the test if Medicare denies payment.

Medicare Secondary Payer (MSP) information must be provided on all Medicare beneficiaries. MSP information must be no older than 60 calendar days from the date of service.