FSHD1 and FSHD2 Billing Directives

Please read: FSHD1 and FSHD2 Billing Directives

Referring Institution (Client) Invoicing

The UIDL produces client invoices once each month. The invoices itemize the date of service (collection date), patient name and date of birth, charge description, CPT code, and price of each test performed. Payment of the invoice is due within 30 days of receipt. The client is responsible for applicable insurance and patient billing.

Cases Originating From Within The United States

Insurance Billing

Private Insurance and Managed Care Organizations

As a service to your patients, and in compliance with agreements established with insurance and managed care companies, UIDL will bill your patient’s insurance carrier(s) or managed care organization directly when provided with complete and accurate billing information. For those insurance companies and managed care organizations where a contract does not exist with UIDL, we will still file a claim to those carriers. Your patient may or may not have out-of-network coverage. It is the patient/provider’s responsibility to vet insurance carrier coverage. This includes determining whether prior authorization is needed and whether the patient has out of network laboratory benefits which will allow payment to the UIDL

Below is information required by the payer to determine coverage and/or prior authorization requirements. Additional information (e.g., CPTs) are available via the University of Iowa Diagnostic Laboratories Test Directory Handbook. Please contact the UIDL Reference Billing team via email (UIDLReferenceBilling@healthcare.uiowa.edu) or phone (866-844-2522) if additional details are required or if there are any questions.

Medicare

The UIDL will bill Medicare. In the event a health care practitioner orders tests that Medicare deems medically unnecessary, a properly executed Advance Beneficiary Notification (ABN) must be secured by the client prior to collection of the specimen. The ABN form must accompany the specimen to our laboratory and enables the UIDL to bill the patient if Medicare denies our claim for medical necessity or frequency limitations. In the absence of a properly executed ABN, the UIDL will bill denied charges back to the client.

It is the referring institution’s responsibility to ascertain the need for the ABN; however, the below tests are known to require an ABN. Note, this list is not exhaustive.

IMPORTANT: Medicare will only pay for the services that it determines to be “reasonable and necessary” under section 1862(a)(1) of the Medicare Law. If Medicare determines that a particular service, although it would otherwise be covered, is not “reasonable and necessary” under the Medicare standards, Medicare will deny payment for that service or test.

Iowa Medicaid

Medicaid claims can only be filed after all other third-party resources have been exhausted. Patients should be asked at the time of service if there is other coverage, such as Medicare, Medicaid HMO, or private insurance. When applicable, any Medicare, private insurance, or managed care (HMO) information should also be provided. If Medicaid denies payment for non-covered services or eligibility reasons, the patient may be responsible for the payment. Medicaid is always the last source of payment.

Non-Iowa Medicaid

The UIDL can only file Medicaid or state aid claims in Iowa. Prepayment is required before the UIDL will perform testing. To initiate payment and expedite testing, please complete the Prepayment Form.

Patient Billing

As a service to patients, and in compliance with agreements established with insurance and managed care companies, UIDL will bill the patient’s insurance carrier(s) or managed care organization directly when provided with complete and accurate billing information. The UIDL will work diligently to ensure claims are fully and properly adjudicated, and we do our best to obtain reimbursement from insurers. However, below are some of the circumstances that may result in the patient receiving a bill from us are:

• The patient has non-government insurance and are responsible for a co-payment, co-insurance, deductible, and/or non-covered services.
• The patient has Medicare and is responsible for 20% of the amount Medicare has set as the cost of the test.
• The patient has Medicare and has signed an ABN (Advanced Beneficiary Notice). Once a claim is fully adjudicated, there may be a residual guarantor responsibility identified that the patient may receive a bill for directly from the UIDL.
• Required prior authorization for testing was not properly obtained prior to testing.
• Additional information to successfully file insurance claims on the patient’s behalf was not received in a timely manner.

The patient should contact their insurance carrier directly, should they receive a bill from the UIDL and feel their insurance claims were not processed correctly. If necessary, UIDL billing resources are always available via email (UIDLReferenceBilling@healthcare.uiowa.edu) or phone (866-844-2522).

Iowa Resident (No Insurance)

The UIDL produces patient statements once each month. The statements itemize the date of service (collection date), lab test(s), ordering provider, and applicable charge(s) for each test performed. Payment of the statement is due within 30 days of receipt.

Non-Iowa Resident (Medicaid or No Insurance)

Prepayment is required before the UIDL will perform testing. To initiate payment and expedite testing, please complete the Prepayment Form.

Cases Originating From Outside Of The United States

Prepayment is required before the UIDL will perform testing unless the UIDL has previously approved client invoicing. To initiate payment and expedite testing, please complete the Prepayment Form.

Payment Options

Consent To Release Information

Important: The University of Iowa Diagnostic Laboratories (UIDL) is committed to protecting the privacy of the patient base we serve. Should you contact the UIDL Billing Office at 866-844-2522 about a bill for reference laboratory services for someone other than yourself (i.e. spouse, child or other relative), we must have a consent form signed by the patient to assist you with your call.

Current Procedural Terminology Coding (CPT)

CPT Codes are provided in the University of Iowa Diagnostic Laboratories Test Directory Handbook as a convenience to our clients. CPT codes are subject to change at any time; it is the client’s responsibility to verify their accuracy for the test performed. Clients are encouraged to consult the CPT Coding Manual published by the American Medical Association and to address questions regarding the use of any particular code to their local Medicare carrier.