Billing for Labs

Labs require that you provide them with the type of billing, and the insurance info if they are to bill the insurance company.  Sending this information with Allscripts Enterprise (formerly TouchWorks EHR) requires consideration of work flows and design.

Insurance information is easy with Enterprise – you store the insurance with the patient’s record from the Practice Management System (PMS), and then send it along to the lab with each Order placed in Enterprise.

Bill Type is pretty easy too – for the majority Orders that are placed.  Most clinics have certain rules that govern the insurance to be used.  It can be as simple as the clinic always bills the patient or their insurance, or they always have the lab bill.  There are times when the insurance or the order being placed may contribute – sometimes this logic is built in to your interface, other times it’s not deemed worth the build effort.  And, there may be other factors – such as the patient indicates that the reason for their visit is due to an on-the-job injury (Workers Comp).
I have not found a great solution for handling the exceptions, but I did see an interesting solution a few months back that works pretty well.

A group I was working with stumbled upon the Special Billing (aka Injury Type) dictionary and asked if we could use it.  We thought about it for a bit and it seemed to meet a lot of the needs that we had:

  1. No impact on other modules – for them, and perhaps not for you, they did not send Special Billing information back to their PMS.  This is the only standard use for Special Billing information.
  2. It affected all orders on a particular encounter – in their case they knew that all labs should be billed by the lab, except when they shouldn’t.  They could not determine the rules for exceptions from talking to the clinic – the employees there said they just knew when the clinic should bill and all orders for the encounter should follow that exception.
  3. It was sent to the ConnectR interface.
  4. They could create their own entries – such as “Client Bill”, “Third-party Bill” and “Patient Bill” (the three values the lab would accept).

Then we were on our way – a small change to the interface to override the logic we had built based on Special Billing / Injury Type, if it was set.  They added the appropriate entries and trained the users to pop in to the Encounter Form and set the Sp Billing value to “Client Bill” if the clinic should charge for the blood work.  It’s a great solution for groups that are otherwise not using Special Billing in Charge.

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    My question is: My lab has a draw station in a dr.’s office. I get patients that don’t have ins. so I have to patient bill them. When they get their bill they are to bring it to the Dr.’s office and they in return rebill the patient at a considerable discount (basically what the lab charges the dr. they bill at their charges) I didn’t think that you could bill the patient for the same labs after they have already been billed. Doesn’t that undercut the labs and their profit margins? Doesn’t seem to right.

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