At your discretion, Bio-Reference will (1) bill your office directly for services rendered to your patients (in those States that allow doctor billing), (2) bill your patient directly or (3) bill any of the third party insurance carriers that Bio-Reference is able to bill directly, if your patient is an enrollee of one of these third party carriers and, if you provide us with the necessary information.

Our computerized billing department submits electronic claims to our insurance carriers plus individual statements to patients and clients. Bio-Reference is currently a provider for the insurance companies listed below:

1199 National Benefit Fund
Allied Welfare Fund
Americaid
American Medical Life Insurance, Co.
American Preferred Provider Plan
Blue Shield of New Jersey, New York,
Connecticut, Pennsylvania, Florida, Texas
Careplus Health Plan
Champus
Complete Care
Federal Black Lung Program
G.H.I.
Health Care Payers Coalition of NJ
(effective 5-27-98)
HealthSource (P.P.O.)
HEALTHNET & BLUECHOICE (HMO and PPO of N.Y.B.S.)
J.J. Newman & Co.
Local 812, Softdrink & Brewery Workers
MagnaCare
Managed Health, Inc.

Medicaid of Connecticut, DC, Florida, Illinois, Indiana, Kentucky, Louisiana, Maryland, Minnesota, New Jersey, Pennsylvania, Texas and Virginia
Medicare
Multi Plan, Inc.
The National Care Network
National Health Plan
Ohio Bureau of Worker's Compensation
P.H.C.S. (Private Healthcare Systems)
POMCO
Select Pro
S.O.L.O. (Solidarity of Labor Organizations International Union)
S.W.S.C.H.P. (State-Wide Schools Cooperative Health Plan) (NY)
United Healthcare (Empire, General Motors, NY Power Auth., L.I.R., Health Research and Con Ed)
U.S. Healthcare (as of 11-1-96, Fertility Testing Only)
Wellness Plus
Westchester Prepaid Services, Inc./Health Source

Direct Billing To The Patient

Bio-Reference will bill your patients directly for our services. The patients full name, street address including apartment number, city, state and zip code must be clearly printed in the space provided on the requisition (including Social Security Number). A complete address at the time the test is ordered is essential. Each requisition will result in a separate bill to the patient. Payment of patient bills is due upon receipt and, if not paid, will be followed by subsequent reminders and normal collection activity.

Direct Billing To Medicare
As a result of legislation signed into law on July 18, 1984, Bio-Reference is required to bill Medicare directly for all laboratory testing (with the exception of anatomic pathology) that is referred to us by any physician. Except in those cases, Medicare will deny payment to anyone other than the laboratory that performed the test. Please be sure to identify any of your patients who are eligible for Medicare coverage by so noting on the test requisition.

In order to bill Medicare, we require the following information. If you have any questions, please feel free to call us.

1. Patient Name
2. Patient Address (Including Zip code)
3. Patient Sex
4. Patient Signature
5. Patient Medicare (HIC) # 9 numerics plus 1 or 2 alpha/numeric suffix). If United Healthcare (1-3 alpha plus 6-9 numerics)
6. Medicare currently requires that you provide an appropriate diagnosis code for specific laboratory tests.
7. Referring Physician and UPIN (1 alpha 5 numerics)

Direct Billing To Third Party

For patients who are subscribers or recipients of benefits from one of the agencies listed on page 47, Bio-Reference will bill the patient directly for services not covered by their contract or program, for any amount that has been applied towards a deductible, and for any balance due after payment up to the terms of their specific contract. Payment is due upon receipt, and if not paid, will be followed by subsequent reminders and normal collection activities. Please be certain to include all necessary information in the space provided on the requisition at the time the test is ordered. Complete information avoids the need to interrupt and impose upon your staff or patients with requests for information not initially provided.

AGENCY AND REQUIRED BILLING INFORMATION


New Jersey Medicaid

1. Patient Name
2. Patient Address
3. Patient Date of Birth
4. Patient Sex
5. Patient Signature
6. Medicaid ID # (10 numerics plus 2 numerics/person # suffix)
7. Diagnosis Code
8. Referring Physician and provider number (7 numerics)
9. Physician Signature


Connecticut Medicaid

1. Patient Name
2. Patient Address
3. Date of Birth
4. Patient Sex
5. Patient Signature
6. Medicaid ID # (9 numerics)
7. Diagnosis Code
8 Referring Physician and provider number
9. Physician Signature


New Jersey, New York, Connecticut, Pennsylvania, Florida and Texas Blue Shield

1. Patient Name
2. Patient Address
3. Patient Date of Birth
4. Patient Sex
5. Patient Signature
6. Subscriber Name, Address, Date of Birth
7. Patient's Relationship to Subscriber
8. Blue Shield ID # plus group number
9. Diagnosis Code
10.Referring Physician and Signature

G.H.I.

1. Patient Name
2. Patient Address
3. Date of Birth
4. Patient Sex
5. Patient Signature
6. Subscriber Name, Address, Date of Birth
7. Patient's Relation to Subscriber
8. G.H.I. ID # - Social Security Number plus group number (9 digits)
9. Diagnosis Code
10.Referring Physician and Signature


1199 National Benefit Fund

1. Patient Name
2. Patient Address
3. Date of Birth
4. Patient Sex
5. Patient Signature
6. 1199 National I.D. # (9 numerics)
7. Subscriber Name, Address, Date of Birth
8. Patient Relationship to Subscriber
9. Diagnosis Code
10. Referring Physician and Signature


All Other Insurances

1. Patient Name
2. Patient Address
3. Patient Date of Birth
4. Patient Sex
5. Patient Signature
6. Subscriber Name, Address, Date of Birth
7. Patient's Relationship to Subscriber
8. ID # plus group number
9. Diagnosis Code
10.Referring Physician and Signature

NOTICE

Bio-Reference Laboratories, Inc. has a fiduciary responsibility to remind physicians that when they order tests in which Medicare/Medicaid reimbursement will be sought, physicians should only order tests that are “medically necessary.” This means that only tests which are required for the diagnosis or treatment of a patient can be ordered for tests reimbursed by Medicare/Medicaid. This government policy eliminates all testing for screening purposes only.

Medicare Patients Must Pay For Tests Ordered Outside Utilization Guidelines

Utilization parameters have been developed based on comments received from Medicare’s Carrier Advisory Committees and Professional Consultants for   laboratory tests. The parameters represent the normal utilization of the test. Medicare recognizes that some clinical conditions may require testing at a frequency which exceeds these guidelines. Likewise, providers may find testing at lower frequencies to be appropriate. Claims submitted for services which exceed these guidelines require additional documentation before payment is made.

Glycated Hemoglobin (83036)
1 every 3 months, except 1 per month during pregnancy
Lipid Panel (80061) 1 every 4 months
Ferritin (82728) 1 every 2 months
Pap Smear (88156) 1 every 3 years

When ordering any of the tests above outside of their corresponding utilization guidelines and without additional documentation, please have the patient sign the Patient Waiver Section of the requisition form, so they may be billed directly for the test.

Procedures Of Questionable Current Usefulness

The following tests are considered "Procedures of Questionable Current Usefulness" by Medicare and require documentation which satisfactorily establishes the procedure's medical necessity (letter of medical necessity). The reference is Medicare Medical Policy Bulletin No. G-33. If a letter of medical necessity can not be provided, please have the patient sign the Patient Waiver section of the requisition form, so they may be billed directly for the test.

LAB TEST CODE	DESCRIPTION	CPT CODE
1232	17-HYDROXYPREGNENOLONE	84143
1613	3-ALPHA ANDROSTANEDICOL-G	82154
2128	ADRENAL STEROIDS	84999
0608	ANTI-GLIADIN AB., SERUM	84999 x 2
0451	APOLIPOPROTEIN A1	82172
1639	LIPOPROTEIN a (Lp-a)	82172
0457	APOLIPOPROTEIN B	82172
0895	APOLIPOPROTEIN A-1, B	82172 x 2
0427	ARSENIC 24 HR. URINE	82175
0845	ARSENIC BLOOD	82175
2155	ARYLSULFATASE A, 24 hr. URINE	84999
1447	ATRIAL NATRIURETIC FACTOR (ANF)	84999
1310	BETA ENDORPHIN	84999
1596	CORTICOTROPIN RELEASING HORMONE	84999
2426	ENDOTHELIN-I	84999
1428	FELBAMATE	80299
1611	FIBRONECTIN AGGREGATES, IGA	84999, 82784
0111	HEXOSAMINIDASE A (TAY SACHS)	84999
1866	HYDROXYCORTISOL 18	84999
1316	IGF-BP3	84999
2474	INSULIN-LIKE GROWTH FACTOR II	84999
1104	INTERLEUKIN-1b (IL-1b)	84999
1026	INTERLEUKIN-6 (IL-6)	84999
0398	LEAD, BLOOD	83655
0808	LEAD, URINE (24 HR.)	83655
0631	MELANO. STIM. HORMONE (GAMMA)	84999
0635	MELANO. STIM. HORMONE (BETA)	84999
0632	MELANO. STIM. HORMONE (ALPHA)	84999
1304	MESANTOIN, SERUM	84999
1270	METHYLDOPA (ALDOMET)	80299
0909	MHPG, 24HR. URINE	84999
2192	MYELOPEROXIDASE Ab.	84999
2154	NEURONTIN (GABAPENTIN), SERUM	80299
2165	NIACIN LEVEL	84999
1368	NITROGLYCERINE	80299
1594	PEPSINOGEN, SERUM	84999
0963	PROPOXYPHENE, URINE, QUAL.	80299
0232	SELENIUM, SERUM	84255
1767	SILICATE Abs. (IgG/IgM)	84999 x 2
2078	SILVER LEVEL, 24 hr.	84999
1716	SULFATIDE ANTIBODY, IGM	84999
2105	TH1-TH2 EVALUATION	84999 x 4
0415	THIOTHIXENE, PLASMA	80299
2127	THYROTROPIN RELEASING HORMONE	84999
1266	TOCAINIDE LEVEL	80299
2163	TROPONIN-I	84512
2098	TRYPSINOGEN, SERUM	84999
2148	TRYPTASE, SERUM	84999

Experimental Investigational Tests

These tests are considered experimental/investigational by Medicare. Services performed in connection with research or experimental studies are excluded from payment and therefore require that the patients sign the Patient Waiver Section of the requisition form. The following CPT codes were acquired from the Medicare Reference Manual, Chapter 6 : 82523, 85337, 86343, 86602, 86619, 86682, 86717, 86723, 86732, 86741, 86750, 86753, 86768, 86771, 86774, 88358, 88371, and 88372.

LAB TEST CODE	DESCRIPTION	CPT CODE
1143	AMOEBA ANTIBODY PANEL (ID/IHA)	86753
1713	COLLAGEN STUDIES	82523
5585	DNA PLOIDY (IMAGE ANALYSIS)	88358
1752	LISTERIA AB IGG	86723
2158	N-TELLO PEPTIDE/COLLAGEN	82523
1636	SALMONELLA ANTIBODIES (G/A/M)	80099
2145	SEND-OUT (DNA PLOIDY/IMAGE)	88182
0974	TETANUS ANTITOXIN ASSAY, SERUM	86774
0460	TYPHUS FEVER ANTIBODY	80099

Non-Covered Tests

These tests are considered "non-covered services" and will not be paid for by Medicare. These tests DO NOT require that the patients sign the Patient Waiver Section of the requisition form: 81025, 81050, 83518, 86710 and 86735.

LAB TEST CODE	DESCRIPTION	NON-COVERED CPT
0689	CHLAMYDIA AG. IMMUNO.(GENITAL)	87320
0726	CHLAMYDIA AG. IMMUNO.(URINE)	87320
0818	INFLUENZA Ab. TYPES A/B	80099
1855	LYME AG URINE	87449
1151	MUMPS VIRUS TITER (IgM)	86735
0316	MUMPS VIRUS AB. (IgG)	86735
0946	PARA-INFLUENZA Ab.	80099
2006	PARK AVE PREGNANCY URINE	81025
0133	PREGNANCY URINE	81025
0643	URINE VOLUME (TIMED PERIOD)	81050

Medicare has instituted certain changes with regard to the processing of laboratory claims for Medicare patients that affect both the laboratory and the physician. Most of you are aware that if a diagnosis code does not accompany a Medicare claim, the claim will be rejected.

However, on June 3, 1996, Medicare instituted a new policy; whereby payment for the following tests will only be made if an Appropriate Diagnosis Code accompanies the claim.

Effective as of the dates of service listed below, the following laboratory tests require patient diagnosis information in order to be reimbursed:

Test	CPT Code	Date of Service
Alpha-fetoprotein (AFP	82105	January 1, 1997
Bacterial Urine Culture	87086,87088	June 29, 1996
Blood Counts	85007 - 85031	June 29, 1996
Ca125	86316	January 1, 1997
Ca27.29	86316	January 1, 1997
Carcinoembryonic Antigen	82378	June 3, 1996
Digoxin	80162	June 29, 1996
Ferritin	82728	June 3, 1996
Glucose	82947, 82948, 82962	June 3, 1996
Glycated Protein	82985	June 3, 1996
Glycated Hemoglobin	83036	June 3, 1996
Hepatitis	86287, 86289, 86290, 86291, 86302	April 28, 1997
Lipid Panel	80061, 82465, 83718, 84478	June 3, 1996
Magnesium	83735	June 3, 1996
Pap Smear	88156	May 15, 1995
Phosphate, acid prostatic	84066	June 29, 1996
Prostate Specific Ag (PSA)	84153	June 3, 1996
Prothrombin Time	85610	June 29, 1996
Syphilis Test, Qualitative	86592	June 29, 1996
Thyroid Function Studies	80091, 80092, 84436, 84443, 84479
Treponema Pallidum (MHA-TP RPR Confirm Test)	86781	Oct. 21, 1996

The Medicare Special Notice, dated April 23, 1996, states specifically that:

“A provider, by virtue of furnishing a laboratory service to a Medicare beneficiary, is responsible for making a judgment as to whether the service is medically necessary and for informing the beneficiary in writing prior to furnishing the service, of the likelihood of Medicare denial of payment on the basis that the service is not reasonable and necessary. If the provider fails to verify the medical necessity of ordered tests, and the tests are subsequently determined not to be medically necessary, the provider may be held liable for payment unless the beneficiary received advanced notice of the likelihood of the denial.”

Therefore, if the physician does not provide an Appropriate Diagnosis Code for the aforementioned tests listed above, then Medicare will not pay for the test. In order to make the patient responsible for the payment of a test, their written consent must be obtained prior to performing the test. The recommendation of Medicare is that the laboratory should not run the specimen unless it has an appropriate diagnosis code or a patient waiver accepting responsibility for payment of the test. If the physician does not obtain the waiver, then the laboratory, according to Medicare, should contact the patient directly prior to performing the test to obtain a waiver.

Under the U.S. fiscal year 1988 Budget Reconciliation package Congress has approved that beginning January 1, 1998, physicians must provide diagnostic information at the time a laboratory test is ordered. Therefore, it is Bio-Reference’s policy to require diagnosis codes on all requisition forms.

Disease Specific Profiles