With every new change implemented in the laboratory billing field, it seems Blue Cross Blue Shield (BCBS) finds new, inventive ways to hinder the claims process.
As you seek to increase your total revenue and streamline your billing cycle, you have to keep up to date with the best tips and tricks to navigate the nuances of laboratory billing and payer relations.
Let's dive into the next big change that BCBS is updating with their claims payment methods, and find out exactly how to get your drug testing claims processed and paid.
- 80307- Drug test(s) that is presumptive for any number of drug classes by instrument chemistry analyzers like immunoassay, chromatography, and mass spectrometry (with or without chromatography) including a sample validation per date of service.
- G0480-G0483- Drug test(s) that is definitive that can individualize and distinguish drugs including (but not limited to) GC/MS and LC/MS. This method is qualitative, quantitative, and excludes immunoassays and enzymatic methods. Shows 1-22 drug classes including metabolites if performed, and shows specimen validity testing per day.
These codes defined by the CMS, commonly used in testing urine or saliva for substance screening are typically billed in one claim form.
Here is the recommendation by CMS for payment:
Neither 80307 and G0480-G0483 will be payed together.
- Crosswalk the confirmation to G0480-G0483 so you can get paid for 80307 and G0659 together (a crosswalk means you bill a test for the code of an existing, similar test in order to get it paid at the same rate)
What We Have Found That Works:
Through our practices, we have found these two options to work based on the lab's specific circumstances:
- Run both 80307 and G0659 and bill for only 80307 for the screening and G0480-G0483 for confirmation instead of only billing for G0480-G0483. While you won't be getting reimbursed as much at least you're getting paid some.
- Run just confirmation G0480-G0483 since it is payable and you don't incur the cost of running the screen without reimbursement.
Take BCBS of GA for instance. As they contract at rates around 20-30% of Medicare it would pay around 30-35$ for each screening and definitive confirmation test.
As the largest payer in the US, Blue Cross Blue Shield is probably one that you deal mostly with for your lab, and as they update, so must you.
It might be wise to train your billing team to navigate around this roadblock in order to process your claims. Especially because it is a trend that is soon likely to pick up in the rest of the Blue Cross factions across the US.
While your drug testing claims are getting denied for these coding discrepancies, your solution has to be adaptable.
Again, the correct method is circumstantial, but recommendations are leading the way in claim resolution.
Keep this in mind as you move forward with your payers to streamline your billing cycle and maximize your revenue.
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