A Biller Who Goes to Bat in Payment Battles

September 21, 2015

Earlier this year we worked with a client and their biller, Christina Osborne of Quantum Medical Business Service. Quantum does billing for many pathology practices nationwide, and I must say they are a strong biller.

We noticed that two CPT codes were not being paid by Florida Medicaid:

  • 88341 (immunohistochemistry or immunocytochechemistry, per specimen: each additional single antibody stain procedure)
  • 88344 (immunohistochemistry or immunocytochechemistry, per specimen: each additional multiplex antibody stain procedure)

When Christina contacted Florida Medicaid they noted the issue … and changed nothing.  Christina was diligent in her approach and pushed this issue.  Finally, Florida Medicaid came out and said they would update their fee schedule on July 1st for these codes.  (Note they did not say what to do with the old CPTs, which were left unpaid.)

As of July 16th the codes were still not showing on the physician lab fee schedule, but they were on the independent lab fee schedule.  Furthermore, 88341-26 was sporadically being paid at $9.77, yet others were still being denied.

When Christina contacted Florida Medicaid again, she was advised to just bill them as 88342-26.  Wisely she chose to hold off billing this code.

Here it is September 9, and Christina is happy to report that Florida Medicaid is now paying these claims correctly. Nine months after they were supposed to, they finally got it correct. This process took numerous phone calls and e-mails to straighten out, and it is still not completely resolved.

Imagine if you didn’t have a biller like Christina or a management team like Vachette?  Imagine how many of these issues are being swept aside by your biller, and you simply have no idea. Trust us, we see it every day, and it’s refreshing to work with a biller like Quantum who goes to bat for their clients.

For further information, contact Christina Osborne, Quantum Medical Billing Services at 304-323-4337, or Mick Raich, Vachette Pathology at 517-486-4262.

For periodic payer updates, follow Mick Raich on LinkedIn or check our website.

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