Staffed from 8:30 am to 4:30 pm, Monday through Friday.
PACLAB offers the following billing options:
- Account Billing – Each account is billed monthly.
- Patient Billing – Patients are billed directly.
- Third-Party Billing – Insurance carriers are billed directly.
Knowledgeable billing professionals are always accessible. Beyond the convenience of ready access to assistance, clients have the assurance that comes from decades of experience with payers operating in Washington and throughout the Pacific Northwest.
Unique to the industry, PACLAB's billing statements:
- Provide a cumulative summary detailing all patient laboratory encounters.
- Offer Patient Name, CPT code, test description, cost.
Electronic Data Exchange
PACLAB’s Billing Department uses the latest electronic data interchange (EDI) technology and can bill more than 100 insurance carriers electronically. We have preferred-provider relationships with many carriers.
PACLAB provides our healthcare providers with convenient, professional direct billing to patients. We also provide support to your patients by billing a wide variety of insurance companies directly. In an effort to serve our clients even better, we continually monitor patient usage patterns of various carriers and their associated programs, adding to the list of insurers billed on an ongoing basis.
Requisitions can be preprinted with frequently-used diagnosis codes furnished by the provider to simplify and expedite complete and accurate ordering and billing.
- Our test requisitions can include preprinted diagnosis codes
- ICD9 coding education available – we have various tools designed to help you, staff training, ABN Program on the Internet.
Online ABN Utility Program
Our simple online utility quickly identifies tests that require an ABN and prints an ABN listing those tests and their codes-ready for the patient to sign. ABN Creator automates creation of advance beneficiary notices.
Toll-Free Phone Support
Providing service throughout Washington and the Pacific Northwest, members of the laboratory billing team are available to you and your patients via our toll-free number, 1-800-541-7891.
ICD-9 Coding Support
We can provide support for your ICD·9 coding efforts. Assistance in this increasingly vital area includes staff training, diagnosis code quick-reference cards, waiver forms, waiting room signs, and more.
Ethical Billing Standards
As a member of the Sisters of Providence family, PACLAB is pledged to adhere to the strictest code of billing ethics.
Advance Beneficiary Notice
The Omnibus Budget Reconciliation Act of 1986 (OBRA) included a limitation of liability (or waiver of liability) provision that provides beneficiaries with protection from liability when they, in good faith, receive services from a Medicare provider for which Medicare payment is subsequently denied as not “reasonable and necessary.”
An Advance Beneficiary Notice (ABN) should be obtained whenever a provider has reason to believe a procedure could be denied as not reasonable and necessary. Generally, services necessitating a signed waiver are those that are payable in some instances, but not payable in others. These can include:
Laboratory tests for which Medicare has established either a National Coverage Decision (NCD) or for which a Medicare fiscal intermediary or carrier has established a Local Coverage Decision (LCD).
- Laboratory tests that are not yet FDA-approved or which are termed “investigational tests.”
- Laboratory tests that are specifically excluded by the Medicare program. (e.g., General Health Panels).
- Routine or Screening Services. As a courtesy, please inform your patient that these services are not covered by Medicare.
Please provide the laboratory with an Advance Beneficiary Notice when you have reason to believe Medicare may deny a procedure as ‘medically unnecessary'.
Medicare is very specific about what elements are required on an ABN for it to be considered valid. Absence of any of the required elements invalidates that ABN and is the same as no ABN at all.
Medicare is also very specific about format and appearance of the ABN. Please take a moment to review the ABN that follows. The following must be completed on each ABN obtained:
- Patient’s name
- Medicare number (HICN)
- Specific tests the patient was advised could be denied must be listed.
- The reason these tests may be denied must be listed in the appropriate column.
- The patient may request the estimated cost of the test(s). You should provide this information to the best of your knowledge. Once the information is recorded, ask the patient to read, check Option 1 or Option 2, and sign.
- Patient must date the ABN.
- Patient must sign the ABN.
The procedure for obtaining a Medicare waiver (ABN) is based on the current list of tests for which Medicare requires an ICD·9 code to consider payment. Please refer to the “Current Lab Services That Require Proof of Medical Necessity” list. Do not obtain a Medicare Waiver (ABN) for every Medicare patient, but only for those who may be held liable for the service.
Medicare Secondary Payer
Medicare Secondary Payer (MSP) refers to those instances in which Medicare does not have the primary responsibility for paying the medical expenses for a Medicare beneficiary.
All providers should screen Medicare patients to obtain correct health insurance information before submitting a primary claim to Medicare.
By completing the MSP Questionnaire to initially screen your Medicare patients, you will help reduce costs to the Medicare Program as well as administrative costs to your practice.
Requisitions provided to the laboratory should reflect accurate patient insurance information, including screening for Medicare Secondary Payer. Laboratory Patient Service Center employees will provide Medicare Secondary Payer screening when performing phlebotomy on Medicare beneficiaries. Physician offices that are unable to provide Medicare Secondary Payer screening are encouraged to direct their patients to our Patient Service Centers for this vital requirement of the Medicare Program.
Medicare Part B 1999 Basic Billing Manual
Medicare B New, Issue 167 “Medicare Secondary Payer”
Hospital Manual – Section 295.1, 301-301.2 January 1999
Click HERE to download our complete Billing Guide part A.
Click HERE to download our complete Billing Guide part B.
To submit a Billing question
Click HERE to submit a Billing question.