NEW PM102 Legal Issues in Professional Component Billing
2:00–4:00 pm
2.0 CME CREDITS
Professional component billing, while not permitted under Medicare and opposed by some private insurers, has two distinct advantages for pathologists. Economically, it allows pathologists to be compensated for their services in directing the laboratory for the benefit of patients when the hospital is unwilling to pay a reasonable amount for these services. Philosophically, it helps to establish clinical pathology as a valuable branch of pathology that is no less significant or compensable than anatomic pathology.
In this session, you will listen to the recording of an actual oral argument in an appellate court adjudicating the lawfulness of professional component billing. Participants will discuss how they would answer some of the judges’ questions and consider the implications for structuring a program to bill on a professional component basis. Faculty will also cover other strategies for the compensation of clinical pathology services provided to Medicare patients, patients with traditional indemnity insurance, and managed care patients. The course will suggest a methodology for valuing clinical pathology services and address fraud and abuse issues when a hospital makes no or token payment for clinical pathology services for Medicare patients.
You will learn to:
- Understand the courts view of professional component billing and identify the risks associated with this form of billing
- Develop strategies to mitigate the risks of professional component billing
- Identify strategies to negotiate payment for clinical pathology services by the hospital
Faculty
Jack R. Bierig, JD