Doctor's Data Inc

Billing and Payments

Doctor's Data provides prepaid shipping from the United States, Canada, Australia, Ireland and the United Kingdom. A mailer is included with each test collection kit. If you or your patient opts to upgrade the shipping method or add insurance, these additional charges will be billed to you.

If you are shipping from another country, you must make your own shipping arrangements at your own expense. To ensure efficient test processing and to avoid shipping costs, please follow the steps below.

 

Billing Options Overview

When you are logged into your account or reviewing our fees, you will see list prices and prompt payment prices for each test. The amount billed depends upon the billing option selected.

Bill Physician Account Payment Enclosed Bill to Patient Insurance Filing Medicare Filing
Prompt Pay X X
List Price X X X

Bill Physician Account—The physician is responsible for payment, and qualifies for discounted prompt payment prices when the account is kept current. Not available in New York, New Jersey or Rhode Island.

If a requisition does not have a billing option selected, the physician's account will be automatically billed, except where prohibited by law.

Payment Enclosed—The patient or physician can send payment with the specimen at discounted prompt payment prices. Doctor's Data only quotes list prices to patients. It's the physician's responsibility to provide prompt payment pricing information to patients.

Bill to Patient—The patient is financially responsible and is billed at regular list prices. Patient billing is available only in the United States.

Insurance Filing—The patient is responsible for payment at regular list prices, whether the insurance carrier pays for the claim or not. As a non-participating provider, we do not accept assignment on any commercial insurance plans. Complete insurance and billing information must be provided when the test is submitted, or the patient will be billed and no claim filed. Insurance billing is available only in the United States.

Medicare Filing—The patient will be responsible for any charges not covered by Medicare or subject to an ABN. Medicare is billed at regular list prices.

Physician Accounts

Once you have opened an account, you may order tests that are not covered by Medicare and have the test fees billed to your account or to a credit card on file, or you can submit tests with prepayment. Doctor's Data accepts check and credit card payments in U.S. funds.

A detailed account statement will be issued monthly, and payment in full must be received prior to the next statement date. Please review your statement each month to ensure that all discrepancies are resolved in a timely manner.

Balances over 30 days are subject to a monthly 1.5% service charge. When a balance exceeds 30 days, you may be notified that unless your account is brought up to date within the next billing cycle, prompt payment discounts will no longer apply. Doctor's Data will make appropriate collection efforts in order to assist in bringing the account up to date and to ensure that timely payments are made.

Doctor's Data reserves the right to assign credit limits, and accounts may be subject to a credit review that may include a credit check. Physicians may not legally send payments or be billed in New York, New Jersey, or Rhode Island.

Payment Enclosed with Test

Patients or physicians may send payment with the specimen and receive discounted prompt payment pricing. Doctor's Data accepts check and credit card payments in U.S. funds. Doctor's Data only quotes list prices to patients. It's the physician's responsibility to provide prompt payment pricing information to patients.

For prepaid tests, Doctor's Data will not file claims with an insurance company. An itemized receipt will be mailed to the patient within two weeks of test completion. Many insurance companies accept this receipt in lieu of a claim form. The patient should verify this with their insurance provider.

If the credit card is declined or the check is returned, we will attempt to contact the patient to arrange payment. A $25 fee will be charged for returned checks. If payment is not received within 30 days of the test completion, the patient will be invoiced at regular list prices.

Bill to Patient

A detailed account statement will be issued monthly and payment in full must be received within 30 days. Doctor's Data accepts check and credit card payments in U.S. funds. Balances over 60 days will be subject to a monthly service charge of 1.5%, and we will employ collection efforts as needed until payment is received.

Insurance Filing

Doctor's Data will submit claims at regular list prices to patients' primary and, if appropriate, secondary insurance companies, as long as complete patient information, insurance information, diagnostic information and the patient's signature are all provided on the requisition included with the sample. We do not participate with any HMO or PPO plans and cannot guarantee insurance coverage. The patient should contact their insurance provider to verify "non-participating laboratory" coverage.

Diagnostic codes should document conditions to the highest degree of certainty for that visit, including signs, symptoms, abnormal test results, exposure to communicable diseases and other reasons for the visit.

Ultimately, the patient will be fully responsible for all charges.  When insurance claims are filed, the patient will continue to receive statements until the balance is paid in full. The patient must make payment in full within 60 days, even if the insurance carrier has not responded to the claim.

Doctor's Data accepts check and credit card payments in U.S. funds. Balances over 60 days are subject to a monthly service charge of 1.5% and we will employ collection efforts as needed until payment is received.

Medicare Filing

Doctor's Data will submit claims at regular list prices to Medicare for covered testing ordered by practitioners who meet Medicare's definition of a recognized provider (commonly MD, DO, DPM, NP or PA). Complete patient information—including the patient's Medicare ID number and diagnostic information—must be provided. If an ABN is required for a test, it must be signed. Specimens from Medicare patients without complete Medicare information, including a signed ABN when required, will not be processed and will be placed on hold. Any tests not covered by Medicare are the financial responsibility of the physician or patient.

Medicare will only pay for tests that meet the Medicare coverage criteria and are reasonable and necessary to treat or diagnose an individual patient. Medicare does not pay for tests for which the documentation in the entire patient record, including that maintained in the physician's records, does not support that the tests were reasonable and necessary for a given patient. Medicare does not cover routine screening tests even if the physician or other authorized test orderer considers the tests appropriate for the patient. The ordering physician is legally responsible for documenting and maintaining the medical necessity of each test in the patient's medical record. Tests submitted for Medicare reimbursement must meet program requirements or the claim may be denied.

Doctor's Data, Inc. offers a variety of profiles containing multiple tests. Many tests can be ordered individually, and a list of individual components and prices is available upon request. Ordering a full profile for a Medicare patient may result in the ordering of tests which are not covered, reasonable or necessary.

Advance Beneficiary Notice (ABN)

For tests that are not reimbursable by Medicare or have limited coverage, such as tests subject to a national coverage determination (NCD), Local Coverage Determination (LCD) or Local Medical Review Policy (LMRP), an Advance Beneficiary Notice (ABN) must accompany the requisition. The ABN must be read and signed by the patient and returned with the specimen and requisition before testing can begin. Specimens from Medicare patients without a signed ABN will not be processed and will be placed on hold. A signature on an ABN indicates that the patient is aware that they will be personally and fully financially responsible for payment for those tests that are not reimbursable by Medicare. For more information on filling out the requisition, click here.

For tests that are statutorily excluded from Medicare coverage, a Notice of Exclusion from Medicare Benefits (NEMB) will accompany the requisition. The purpose of the NEMB is to inform the patient that the test is excluded from coverage under the Medicare program, and will not be paid by Medicare under any circumstances. A patient signature is not required for tests subject to a NEMB. The patient or the physician will be personally and fully financially responsible for payment for those tests that are statutorily excluded from Medicare coverage.

Frequently asked questions about Medicare:

Why does the patient need to sign an ABN if the test is being billed to the physician or directly to the patient?

As a Medicare supplier, Doctor's Data must bill any charges directly to Medicare upon receipt of a "demand notice" from a patient. If a patient has not signed the ABN agreeing to be financially responsible for the test prior to the analysis, Medicare can demand that the patient be refunded any payments made to Doctor's Data or the physician.

Why does the patient need to sign the ABN if the ordering physician has opted out of Medicare or has already had the patient sign another ABN?

Even though the physician may have opted out of Medicare, or had the patient sign another ABN, Doctor's Data is a Medicare supplier, and must bill any laboratory charges directly to Medicare. If the patient has not signed the Doctor's Data ABN agreeing to be financially responsible for the test prior to the start of the analysis, Medicare can determine that the patient should be refunded any payments made, regardless of the status of the physician.

Will supplemental insurance pay for tests not covered by Medicare?

Supplemental insurance companies may reimburse for some testing that Medicare does not cover. However, most supplemental plans will not pay for testing that is subject to limited coverage or excluded from Medicare coverage. Patients should check with their supplemental insurance provider to verify coverage.

If a patient knows that Medicare will not pay for the lab test, can Doctor's Data bill directly to a secondary insurance company?

No. In order for a secondary insurance provider to process a claim, they need a denial from Medicare. At the patient's request, Doctor's Data will submit the claim to Medicare and then send the denial to the secondary insurance provider for processing.

What is an NPI?

A national provider identifier or NPI is a HIPAA-mandated, unique, ten-digit identification number issued to all individual health care providers in the US by the Centers for Medicare and Medicaid Services (CMS). All ordering physicians must provide their NPI for insurance or Medicare billing.

 

Billing Policies

Medicaid Information

Doctor's Data does not participate in any state Medicaid programs and will not accept specimens from Medicaid patients.

Changes to Billing Method

Physicians may request a change to the billing option selected within 60 days of the test completion. The physician must provide all information necessary to process the change at the time of the request. Please review your statement each month to ensure that all discrepancies are resolved in a timely manner. After 60 days we will be unable to honor any such requests and the physician will be financially responsible for payment. If the patient Advance Beneficiary Notice (ABN) was not signed at the time the specimen was submitted, we cannot change from physician billing to Medicare filing at any time.

Missing Information

If the required information is not provided on the requisition, Doctor's Data will make three attempts by phone, email or fax to obtain it. After that, we will place the test on hold for 60 days. After 60 days we will cancel the test and the specimen will need to be re-collected.

 

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