I am trying to find out what states allow doctors to add an up charge
for lab testing services. In some states I believe that MDs can add
a charge when they send a sampe to a labfor testing. |
Request for Question Clarification by
hummer-ga
on
03 Dec 2005 06:35 PST
Hi jburd,
Could you please clarify what you mean by "up charge"? The AMA code
of ethics states that a "physician should not charge a markup,
commission, or profit on the services rendered by others" (in other
words, they cannot profit from work they did not perform), but they
can add a processing charge for sending the sample to the lab.
Regards,
hummer
|
Clarification of Question by
jburd-ga
on
03 Dec 2005 09:06 PST
There is a home allergy test "MyAllergyTest" (see www.immunetech.com)
that involves sending a very small blood sample to a lab. I believe
that in some states, if a doctor buys the test from the company that
they can administer the test (that is, collect the fingerstick blood
sample and mail it into the lab). I think that in some states they
can bill an insurance company for whatever they feel like charging.
In some states, since they are sending the sample to the lab and the
lab charges $49.95, the doctor cannot charge for anything above that.
However, I believe that in some states, the MD can bill the insurance
company under the standard CPT code for such a test, and get
reimbursed up to $150. I would like to know what states, if any,
allow this.
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Request for Question Clarification by
hummer-ga
on
03 Dec 2005 11:56 PST
Hi jburd,
I think the following article will be of interest to you (click on the
link to view the entire article) but unfortunately, it doesn't answer
your question. I've searched for the study by Zachary Dyckman without
success, perhaps another researcher will have better luck.
The Wall Street Journal
"How Some Doctors Turn a $79 Profit From a $30 Test"
"Medicare requires direct billing, as do a few states. In some other
states, doctors and local medical societies upset at the prospect of
losing revenue have thwarted such legislation. Some doctors still bill
Medicare for lab work performed off-site by owning "condo" labs within
a larger facility."
"Several studies have shown physicians are more likely to order
services for patients if they have a financial incentive. A 1993 study
compared states where doctors are allowed to bill for outside lab
work and states where they aren't. It found doctors in the former
ordered 28% more tests. The study was conducted by the Center for
Health Policy Studies, a consulting group, for the American Clinical
Laboratory Association, an industry group.
The study's author, economist Zachary Dyckman, says he would expect
the same results today. The extra testing, he says, 'appears to be
done exclusively to earn more revenue and increase profits.'"
"The American Medical Association's code of ethics says under the
heading of laboratory services that a "physician should not charge a
markup, commission, or profit on the services rendered by others." It
adds, however, that doctors can levy a processing charge on such
services. The AMA code says that a doctor 'who chooses a laboratory
solely because it provides low-cost laboratory services on which the
patient is charged a profit is not acting in the best interest of the
patient.'"
http://www.trinity.edu/eschumac/WSJ_com%20-%20How%20Some%20Doctors%20Turn%20a%20$79%20Profit%20From%20a%20$30%20Test.htm
Referral deals give physicians an easy profit
http://www.fortwayne.com/mld/journalgazette/13036560.htm
Regards,
hummer
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