Regional Medical Laboratory

Patient Billing

Self Pays

Patients are encouraged to pay at the time services are rendered or must supply address and phone number to be billed. The South Memorial Patient Care Center at 8131 S Memorial Dr, STE 104 offers a 30% discount if payment is made in full at the time the lab work is drawn. If the patient pays billed charges within 30 days we offer a 25% discount for that service.

Insurance Filing

Regional Medical Laboratory will file Primary and Secondary with any insurance (except those listed as Non-Contracted) if all the billing information is received. Depending on plan and whether RML is in-network, patients may be responsible for the entire bill, co-pay or deductibles. It is the patient’s responsibility to verify if RML is in-network lab.

Required information for Insurance billing:

• Front and Back copy of Insurance Card
• Patient Name
• Patient Address
• Patient SSN
• Patient DOB

Medicare Filing

Medicare requires the physician to supply diagnostic codes of why lab work is being performed. Medicare generally does not pay for “routine lab work” and the patient will be responsible for payment.

If the diagnostic codes do not justify medical necessity or if a certain test has frequency limitations, we may ask for the patient to sign an Advanced Beneficiary Notice that states we are uncertain if Medicare will pay for this and the patient may be responsible for payment.

We urge the patient to call their physician if there is any question on the diagnostic code that is being submitted. Your physician will need to contact RML if a change in diagnosis codes is needed.

Client Billing

Clients have three billing options; lab charges may be billed to their individual client account, RML can file to their patient’s insurance or RML can bill the patient directly.

Client Bills

Client bills are sent as a monthly statement itemizing dates of testing, patient names, tests requested and associated charges.

Insurance

Regional Medical Laboratory will file Primary and Secondary with any insurance (except those listed as Non-Contracted) if all the billing information is received. Depending on plan and whether RML is in-network, patient’s may be responsible for entire bill, co-pay or deductibles
Required information for Insurance billing:

• Front and Back copy of Insurance Card
• Patient Name
• Patient Address
• Patient SSN
• Patient DOB

Medicare

RML Medicare license number is 37-8087, provider number 73-1131608.

Since October 2003, Medicare requests that all tests will need to be sent with a diagnosis code. Certain test will still require specific diagnosis codes that justify medical necessary. To request a Medical Necessity booklet please call (918) 744-2164 or (800) 331-9102. The Balanced Budget Act of 1997 requires physicians to provide diagnostic information when ordering tests.

If an ICD10 code or diagnosis is not written on the requisition, RML will fax to obtain an ICD10 code. If the ICD10 code given on the requisition does not justify medical necessity, RML will attempt twice to notify the client.

Advanced Beneficiary Notice (ABN) is required when the test does not have an ICD10 code that justifies medial necessity, or if the test is medically necessary but exceeds Medicare’s frequency guidelines. A valid ABN list the test(s), gives a reason why the test(s) may be denied, and has the patients’ signature that if the test is denied, the patient will be fully responsible for payment.

If Medicare denies a test as not medically necessary or routine, RML will verify that an ABN was signed and bill the patient. If an ABN was not signed, and client collected the specimen(s) in their office, RML will have no recourse except to bill the requesting physician for the test(s) ordered, since failure to do so could invoke the anti-kickback statutes that pertain to physician/laboratory relationships.