Hi Histonetters:

I am writing to gather some information on how your billing department
handles the scenerio's below.

Background:

Billing departments have, for various reasons needed
to put a short turn-around time on departments posting charges.  Insurance
Company dictates, wanting to send an all inclusive bill on a patient,
shorten reimbursment time, etc. all very good reasons.  This time frame
has shortened over the years.  

A few years ago, coding could be done from the admitting diagnosis and
billing could be posted as soon as the pathology procedure(s) were
ordered, but Pathology now must ICD9 code the Pathologic Diagnosis, which
is not possible until the case is signed out.

Scenerio's:

The goal is to post billing within 3 days. (this may vary somewhat
institution to institution)  This is possible for some charges, e.g 24hr
biopsies, processed the same day of service. (date of surgery)  
diagnoised and coded the next, if all goes perfect.

The majority of cases follow this or a similar sequence.

Day 1 or 2, Date of Service (not yours, but surgery day)
            Specimen processed overnight. Unless the specimen arives to
            late for grossing and fixation which adds an additional day.

Day 2 or 3, Specimen prepared, and diagnosed, report transcribed, unless
            you are a teaching facility with residents. (usually adds 1
            day)

Day 3 or 4, ICD9 Coded and charge posted

If the specimen requires Special Stains, that usually adds another day
(Day 5 or 6)

If the specimen requires decalcification, that adds 1 to several days
depending on the specimen.

If Immunohistochemistry is needed, the diagnosis is not complete until 2
to several days after the initial Histologic preperation depending on the
case.

Flow Cytometry adds more days to the final diagnosis.
                                         
Molecular Pathology testing takes about 2 weeks from date of service.

Cytogenetics testing takes 14 days from date of service to complete for
most specimens. 

So, the question is, how does your institution deal with the fact that the
tests take longer to do then the goal of posting charges?

Dose the billing department send additional billing to the Insurance
Companies?  Do they reimburse?  Does the institution write off your
charges as deducts?  OR have you found a way around that fits all
regulations?

Please, send your ideas and thoughts.  I'm sure some of you may not know
what the billing department does, once they get the posted charges from
you, but please send your way of handling it within the department.

If you have a contact person in your billing department that I could
e-mail or phone to discuss, please send the contact information.
     
Thanks, and Happy Mother's Day to you Mom's out there!
Don
P.S. Gotta clean this one up before retiring :)                    
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Don Hammer, Administrative Director            UNIVERSITY OF WASHINGTON 
Hospital Pathology, Box 356100                     MEDICAL CENTER
1995 NE Pacific St.                                
Seattle Washington, 98195                  ~Where Knowledge Comes To Life~ 
(206) 598-6401 Fax: (206) 598-4928         
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