The College of American Pathologists (CAP) offers resources to assist pathology practices facilitate appropriate medical billing and coding efforts.
Billing and Coding Basics - How Pathology Practices Get Paid
Learn the various methods of payment as well as where to find billing and coding resources in this short video .
Payment methods to be reviewed include:
- Fee for service (FFS)
- Technical Component (TC)
- Professional Component (PC)
- Global Method
- Part A
Analyzing and Interpreting Billing Reports
Maximizing your revenue through a regular and routine review and analysis of your billing performance is paramount to your practice’s financial wellbeing. A proper analysis and interpretation of your billing reports will likely reveal a great deal of diagnostic information concerning the health of your practice.
The CAP’s Analysis and Interpretation of Billing Reports guide is designed to provide you with a framework to assess the vital signs of your practice and identify underperforming areas so you can create action plans to address the issues impacting the financial success of your practice.
Our Analysis and Interpretation of Billing Reports Quick Reference Guide is a useful tool to have on hand for referencing benchmarks and other key performance indicator targets you should be aware of as you review your monthly billing reports.
Alternative Payment Mechanism Resources
This unique glossary of alternative payment model terminology provides definitions and explanations for over 400 words, names, and abbreviations.
Centers for Medicare and Medicaid Services (CMS) Resources
- Clinical Pathology Interpretation Toolkit
The toolkit includes information on implementing billing services based on CMS regulations.
- CMS Denials for Nonhospital Claims
Practices who receive denials for nonhospital technical component services on the same day as hospital services can request reprocessing of claims, for denials claims processed on or after January 1, 2014, that meet the criteria.
- CMS Online Manual System
Policies, and procedures based on statutes, regulations, guidelines, and directives for those administering CMS programs.
- Medicare Claims Processing Manual (Payment for Pathology Services)
- National Correct Coding Initiative Edits
CMS developed coding policies.
- Medicare Coverage - National Coverage Determinations
CMS determinations as to whether a service is reasonable and necessary
Current Procedural Terminology (CPT) Codes
Access the direct billing resources and find a list of states with direct billing, anti-markup, or disclosure laws.
HIPAA-Full Analysis of HITECH-HIPAA
The Department of Health and Human Services' Office for Civil Rights posted the HITECH Act's HIPAA modification final rule (PDF, 436 KB) to the Federal Register. AHIMA staff experts have released a full analysis of the lengthy rule.
International Classification of Diseases (ICD)
ICD-10-CM will be required for physician and clinical laboratory claims effective with October 1, 2015 dates of service.
Basic training for pathologists
The following resources will introduce you to ICD-10 and provide examples by specimen type of how to use free online resources
- Why ICD10?
Introduction video to ICD-10 Coding
- Demonstrating how to use free online resource ICD10data.com to do ICD-10-CM coding
ICD-10-CM Coding Dermatology Examples
ICD-10-CM Coding Gastrointestinal Examples
Pathologist specific ICD-10 Resource
- Centers for Disease Control ICD-10-CM Official Guidelines for Coding and Reporting 2015
(eg, Chapter 2: Neoplasms) Essential guidance from CDC
General ICD-10-CM Resources
- American Health Information Management Association (AHIMA)
- Workgroup for Electronic Data Interchange (WEDI)
- Health Information and Management Systems Society (HIMSS)
Select CMS Resources
- CMS ICD-10 Resources
Trail head to CMS's ICD-10 resources
- Basic Introduction to ICD-10-CM
- Quick Reference Information
- NCDs and LCDs
ICD-10-CM Coding Books
- Detailed Instruction for Appropriate ICD-10-CM Coding* ISBN-10:1622540654
- Advanced Anatomy and Physiology for ICD-10-CM/PCS* ISBN-10: 1622020103
- Principles of ICD-10-CM Coding 3rd Edition* ISBN-10: 1603599487
- Principles of ICD-10-CM Coding Workbook 3rd Edition* ISBN-10: 1603599495
National Provider Identifier (NPI)
Apply, maintain, or lookup National Provider Identifier for individuals and organizations NPI numbers.
Use the following files to connect your practice with your patients.
- Patient-Friendly Explanation of Pathologist Services
This sample document is intended to help practices explain pathologist services to patients.
- Patient Friendly Agreement to Pay Pathologist Services
This document is a sample of a hospital patient registration document for clinical pathology charges.