Chromosome and FISH Billing Practice Changes Not Requiring File Definition Updates
EFFECTIVE MAY 1, 2016
In our continued efforts to improve the client experience, we will be implementing changes to our chromosome and FISH billing practices on May 1, 2016.
As part of this implementation, the structure of chromosome and FISH billing was modified to enable initiation of reimbursement in a timely manner. As with previous changes, our main goal is to keep the change price-neutral for our clients.
WHAT SPECIFICALLY HAS CHANGED?
- Chromosome Testing
While the defined Current Procedural Terminology (CPT) codes are not changing, the culture code will now be included as part of the orderable test, along with the interpretation code.
- FISH Testing
While the defined CPT codes are also not changing, the initial FISH probe code will now be included as part of the orderable test, along with the interpretation code.
WHY WAS THIS CHANGE MADE?
- Allow clients to initiate billing at the time of order
For clients whose practice requires billing upon order, this change enables the initiation of a claim for reimbursement in a more timely manner. While the additional tests report will still be needed, these updates will also reduce the amount of effort required to manage the bill-only codes associated with the culture and initial probe set.
WHAT BENEFITS REMAIN THE SAME?
- Identify accurate CPT codes more easily and ensure appropriate billing at the time of resulting
Concise identification and application of CPT codes for these tests removes the onus from the client to apply the correct codes and ensures that clients are billing appropriately.
- Improve CPT compliance
With additional scrutiny being placed on reimbursement and the potential for an audit from Centers for Medicare and Medicaid Services (CMS), it’s important to prevent overbilling by providing clients with the appropriate CPT codes based on the testing performed. Because CMS identifies candidates for audits by comparing an organization’s billing documents with those from similar-sized laboratories, an organization with increased billing could heighten the likelihood of an audit.
- Strengthen utilization management initiatives
Greater detail and clarity around CPT codes can enable institutions to identify and implement utilization management initiatives, especially around the number of FISH probes performed.
- Prepare clients for value-based reimbursement
Volume-based reimbursement is quickly giving way to new value-based payment initiatives. Taking the necessary steps to prepare for this transition will help clients remain successful in a new health care environment.
HOW WILL WE ASSIST YOU WITH THIS TRANSITION?
- Refer to the Mayo Medical Laboratories Test Announcements (Chromosome | Metaphase/Interphase FISH | Interphase FISH) to guide you on the necessary charge master updates.
- The Mayo Medical Laboratories Billing Office is available to address questions and concerns and may be contacted at (800) 447-6424. Your field staff representatives are also available to discuss questions and concerns.