Insurance and Billing
Q: Why was my specimen submitted to IMMCO?
A: The physician referring the testing to IMMCO identified the patient as a potential Sjögren’s Syndrome case. Early presentation of this disease may involve dry eye / dry mouth; however, as these symptoms may be caused by a number of other conditions, laboratory diagnostics are required to identify cases and initiate appropriate treatment. Diagnosis of Sjögren’s is typically difficult, often requiring several years before proper diagnosis is established. Because of the difficulty in diagnosing based on traditional criteria it is recognized that Sjögren’s incidence is significantly under-reported.1
Immco offers a panel of tests for Sjögren’s Syndrome that includes traditional immunological markers as well as proprietary markers that may aid in identification of Sjögren’s cases at an early stage and/or in individuals that do not express high levels of traditional antibody markers such as anti-SS-A (Ro) and anti-SS-B (La) antibodies.2 These proprietary tests are available exclusively from IMMCO Diagnostics, Inc.
Q: Does insurance cover these tests?
A: It depends on each individual insurance plan. Generally, insurance providers will pay the reimbursed determined by your particular insurance plan. In certain cases, however, an insurance provider may require pre-authorization for testing that needs to be requested by the Physician that referred you for the testing. If the person tested has a deductible that has not been met, that person will be responsible for the amount the insurance states is patient responsibility. If you are experiencing difficulty in paying the patient responsibility, please contact our billing department at 800-537-8378 and we will work with you to structure an appropriate payment plan based on your financial needs.
Q: How can I assure insurance will cover this testing?
A: Call your insurance provider or ask the staff of your physician’s office. Your insurance provider should be able to provide information about what is covered by their plan and whether special pre-authorization for testing is required. The physician’s office may be aware of particular requirements of plans in your area.
Make sure to provide the physician’s office with complete insurance information, including any secondary insurance. IMMCO will bill the insurance provider(s). However, if you have a deductible plan, your deductible will need to be met even if you have an authorization supplied by your physician. If you require additional assistance or information before being tested, please call the IMMCO billing department at 800-537-8378.
Q: Can IMMCO tell me if special restrictions apply to reimbursement or if pre-authorization are required by my insurance provider?
A: Since there are many insurance providers, many more insurance plans offered by these providers, and the plans change frequently, IMMCO is not able to provide this information about specific insurance providers. This information may actually appear on your insurance card.
As a third party laboratory, IMMCO cannot obtain pre-authorization for a patient. However, we will send a courtesy bill to any insurance company that we are not currently working with. If you require assistance or information before being tested, please call the IMMCO billing department at 800-537-8378.
Q: What is an out-of-network laboratory?
A: Certain insurance providers reimburse testing for those laboratories with which they have established contracts and only those laboratories. A laboratory that is not under contract with an insurance provider for particular testing is an “out-of-network laboratory.” Patients may need pre-authorization or pre- notification to obtain reimbursement for fees charged by an out-of-network laboratory.
Q: What is pre-authorization?
A: Certain insurance providers require a patient to contact them for approval to see a specialist or access services from health care organizations that are not under contract with them. Generally, pre-authorization is requested from the physician for the patient before testing is done and to cover reimbursement of fees for such testing. If you have questions or concerns about whether pre-authorization for Sjögren’s testing is required by your insurance plan, we encourage you to contact your insurance provider.
Q: Can IMMCO guarantee full reimbursement?
A: No. IMMCO cannot guarantee full reimbursement; however, our billing department will send a courtesy bill to all insurance providers. If you have questions about reimbursement or problems with your bill, please call the IMMCO billing department at 800-537-8378 and follow the prompt to reach a service provider.
Q: What insurance companies does IMMCO work with?
A: IMMCO works with state Medicare plans and many other providers. However, the list of plans with which IMMCO participates frequently changes. IMMCO does not accept Medicaid. Please call the IMMCO billing department at 800-537-8378 and follow the prompt to reach a service provider if you have any questions.
Q: What do I do if my insurance provider needs more information about this testing?
A: Please refer your provider to the IMMCO billing department at 800-537-8378. They will be happy to answer any of the provider’s questions.
Q: What are the charges for the Sjögren’s testing?
A: The chart below show the pricing and CPT codes for this testing. The amount charged will change based testing needed and completed.
|001A- ANA Titer and pattern on HEp-2 *||$37.63||86039|
|001C- ANA Screen on HEp-2||$35.00||86038|
|011 Rheumatoid Factor (RF); IgG, IgA & IgM||$64.50||86431|
|045 SS-A (Ro)||$45.00||86235|
|046 SS-B (La)||$45.00||86235|
|094 Salivary Protein-1 (SP-1) unit price $43.00 X 3 units||$129.00||83520|
|095 Carbonic Anhydrase (CA-6) unit price $43.00 X 3 units||$129.00||83520|
|096 Parotid Specific Protein (PSP) unit price $43.00 X 3 units||$129.00||83520|
|*If titer is not needed this test will not be done and the cost will be $579.13|
Q: Is there a charge for a Quantity Not Sufficient (QNS) sample?
A: A specimen is reported as QNS when too little blood has been received to complete testing with a request that the physician contact the patient to obtain a better specimen. Immco does not charge a fee for QNS samples received.
Q: What does it mean when the EOB contains one of the following messages: wrong insurance ID; insurance and member name do not match; patient cannot be found under ID given DOB and member Name; ID do not match mean on my bill; or similar message?
A: These are all indications that the patient information submitted does not match the information in the insurance company files. When this occurs, Immco will first verify that the information submitted agrees with the patient information provided to us. If so, we will then contact the referring doctor’s office and/or the patient to obtain the correct information. If we are unable to obtain this information, Immco will send the patient a statement with a note to call with correct insurance information. When the information is received we will resubmit to insurance company. We have a 90 day deadline to resubmit this information to the insurance company, so it is very important we receive this information as soon as possible.
Q: Can bills be resubmitted to insurance providers?
A: Yes. Once the information is corrected we can resubmit to the information to the insurance company for processing.
Q: What is the timeline from specimen collection to write-off?
A: The timeline is detailed below:
- Specimen is collected at Referring Physician’s office, blood draw station or laboratory
- Specimen shipped via FedEx to Immco Diagnostics
- Specimen is received and accessioned in Lab [+1 to 3 days]
- Immco performs testing [+2 to 5 days]
- Testing complete and results sent to referring physician by fax and mail, results uploaded to Immco Online
- Testing order forms given to Billing Department
- Billing Department processes claim and mails to insurance companies daily [+3 to 8 days]
- Medicare and BCBS electronic claims are sent via inter net every Friday
- First response/reimbursement from insurance company [+25 to 55 days]
- If we receive a rejection we will first call the insurance company to review the issues one-on-one. If the claim was rejected because of improper coding, we will correct the information. If claim is rejected because insurance ID does not match patient information, we review all information provided with the specimen, verify billing for correctness, then contact referrer to verify the information they have on file is the same as that provided to us. If so, Immco attempts to contact the patient to get the correct information and rebills as a corrected claim
- If insurance company pays and leaves patient responsibility to the patient deductible or there is co-insurance, patient is billed that day for the amount indicated. The reimbursement cycle is generally 90 days After 90 days or 3 patient billing cycles, and the patient is non-responsive, patient responsibility is sent for collection.
- If the patient has secondary insurance, the balance is submitted to the secondary insurance for payment. Usually within 21 days, there will be a secondary billing payment or rejection received from the insurance company [+46 to 76 days]. Patient will then be billed if the insurance leaves patient responsibility.
- Once final payment is received the billing for that individual is closed.
- This process can take 90 to 120 days to complete, or longer when the patient does not reimburse patient responsibility promptly
Q: What is balance billing?
A: Balance billing is when a company sends the complete bill to a patient even though the insurance company indicates a lesser amount for which the patient is responsible. Immco does not balance bill a patient as it is not allowed by contract and by law. Patients are only billed the amount indicated as the patient responsibility by the insurance company.
Q: How is patient responsibility determined?
A: Patient responsibility is the amount the insurance company leaves to a patient deductible, co-pay or to co-insurance under the insurance plan. If courtesy billing of the patient insurance has been completed, Immco is only allowed to bill to a patient the amount indicated as patient responsibility, no more and no less. Please contact the IMMCO billing department at 800-537-8378 and follow the prompt to reach a service provider if there are issues regarding the amount designated as patient responsibility.
Q: What is dual eligibility?
A: Individuals enrolled in both Medicare and Medicaid are known as “Medicare-Medicaid enrollees” or “dual eligibles”. As a Medicare Provider, Immco Diagnostics agrees to accept payment in full from Medicare for all Medicare-Medicaid enrollees/dual eligibles due to the fact that Immco does not participate with state Medicaid programs.
Patients who have both Medicare and Medicaid coverage and choose to have Sjögren’s Syndrome testing done will not be responsible for any payment when the amount is left to Medicaid as a secondary insurance. Once payment is made by Medicare, Immco will accept this amount as payment in full and write off the remaining balance for Medicare-Medicaid enrollees only.
Q: If I have Medicare, will I be responsible for any out-of-pocket costs?
A: For Medicare individuals who have secondary insurance other than Medicaid, the secondary insurance will be billed. There may be a small amount left as patient responsibility in such a case depending on the individual’s secondary insurance plan. If a patient has Medicare only and a balance is left to patient responsibility, the patient will be responsible for the amount that Medicare states is patient responsibility. In general, however, Medicare combined with secondary insurance leave no balance to be covered by the patient. If a patient has Medicare only and a balance is left to patient responsibility by Medicare, the patient will be responsible for the amount that Medicare states is patient responsibility.
Q: Who can I call for help with insurance issues?
A: If your questions were not answered in this document, please contact IMMCO billing department at 800-537-8378 and follow the prompt to reach a service provider.
Q: Why are my samples being rejected as “QNS”? What can be done to prevent this?
A: If five circles are not filled completely and saturated through the back of the Whatman blood spot card there may be insufficient volume of patient serum to perform the Sjögren’s syndrome panel of tests. You can contact your Immco Customer Service Representative for assistance with technique or for a demonstration on how to use the Sjögren’s syndrome kit. Please refer to Appendix A for examples of acceptable and QNS blood spot cards.
Some helpful pointers are:
- Wash hands with warm water and rub hands together prior to the finger prick
- Keep arm vertical with fingers pointing down so blood pools in finger tips
- Prick finger on side, not directly on pad
Q: I did a Sjögren’s syndrome test on a patient last week and still have not received a result?
A: The expected turnaround time for Sjögren’s syndrome results is within 5 business days of specimen receipt. Generally, samples arriving via FedEx or UPS are received within 2 days of shipment, so results should be issued within 7 business days. If results have been requested via fax, the report will be faxed on the date the report is issued and a hardcopy will be sent via mail as well.
If using Immco Online, you can retrieve results 24/7 once results are posted. Please log on to see if results are available.
If not using Immco Online, there can be several scenarios why a result was not received. For example, if the recipient’s fax machine is being used or offline while the Immco fax is being sent, the Immco fax system will attempt to send the report multiple times, but is unable to continue attempting to send indefinitely. If you believe your results have been issued but not received, we encourage you to call Immco Customer Support at 1-800-537-8378 to request results be re-sent.
To ensure timely receipt of results, please be sure to completely and legibly fill out the test request form enclosed with the Sjögren’s syndrome tests. If you have selected the option for results faxing please ensure your fax machine is on and operational.
Q: I am receiving results for some patients but not others?
A: If a doctor works out of multiple locations, it is crucial that the person completing the test request form accurately fills out where the patient’s results should be sent. If a doctor is using Immco Online to view reports, they will be able to see results for all patients regardless of practice location. If you need to request results to be sent to an alternate location or would like to register for Immco Online, please contact Immco Customer Support at 1-800-537-8378.
Q: I received an error message or am unable to log in to Immco Online to see results.
A: Please email firstname.lastname@example.org with any Immco Online technical issues. If you are unable to access your report and would like to receive the results immediately or would like to register for Immco Online, please contact Immco Customer Support at 1-800-537-8378.
BLOOD SPOT SPECIMEN COLLECTION / QUANTITY NOT SUFFICIENT (QNS)
Q: What is the minimum specimen volume needed for samples collected on a Whatman blood spot card?
A: The absolute minimum volume needed is three complete circles saturated all the way through to the back of the card and filled all the way to the dotted line edge. However, we encourage all five circles to be filled to avoid specimen rejection due to QNS. Please see Appendix A for examples of acceptable and rejected submissions.
Q: Why does Immco need all circles on the card filled?
A: The Sjögren’s syndrome panel consists of multiple tests and it is crucial that enough blood be provided to perform all of the testing. Filling all five circles ensures that the sample will not be rejected as QNS.
Q: Should I absorb blood on both sides of the card?
A: You should not absorb blood on both sides of the card as it may cause uneven distribution of blood in the circles. Filling the circles from one side using large drops of blood (not small dabs) ensures the blood is evenly distributed. Blood that is not evenly distributed can result in varying concentrations, which may affect the accuracy of the results.
Q: I submitted a Sjögren’s syndrome blood spot card with >3 circles filled and received notification the specimen was rejected due to QNS. How is that possible since I exceeded the minimum number of circles?
A: There are several scenarios that can cause a specimen to be rejected due to QNS. It is imperative that the circles are filled completely to the dotted lines and that the blood has soaked through completely to the back of the card so that the entire circle is saturated. Failure to meet these criteria can cause a sample to be QNS. Please see Appendix A for examples of acceptable and QNS blood spot cards.
Q: Is it ok to write or highlight on the blood spot card?
A: Do not write on the card anywhere except for the designated space for patient information. Use pen only, as the ink from highlighters and markers can absorb into the card material and may interfere with results.
Q: Who can perform a “finger stick” blood collection?
A: The single use lancets provided in the Sjögren’s syndrome specimen collection kit are over-the-counter medical devices available to the public. Typically, no special licensure is required for a medical professional employed in a physician’s office to utilize this device to collect blood for the Sjögren’s syndrome test. However, please refer to your state’s regulations to determine if licensure is necessary.
State of California regulations are more restrictive as to who can perform a finger stick procedure. The procedure may be performed by a variety of licensed professionals, such as phlebotomists and emergency medical technicians, and may also be performed by a medical assistant under certain conditions. Although medical assistants are not licensed, certified, or registered by the State of California, they may perform the procedure within a medical practice if they have received proper training. However, the medical assistant’s employer and/or supervising physician’s or podiatrist’s malpractice insurance carrier has the right to require that the medical assistant be certified by a national or private association. Medical assistants providing training to other medical assistant must be certified by one of the approved certifying organizations (Title 16 CCR 1366.3).
Q: Does insurance cover the Sjögren’s syndrome tests?
A: It depends on each individual insurance plan. Generally, insurance providers will pay the reimbursed amount determined by the patient’s particular insurance plan. Some insurance providers may require pre-authorization for testing and the patient will need to work with their insurance provider and the physician referring them for testing to request pre-authorization. If the patient being tested has a deductible that has not been met, that person will be responsible for the amount the insurance states is patient responsibility. Patients should contact their insurance provider if they are unsure about coverage. Please note that Immco Diagnostics does not accept Medicaid.
If a patient is experiencing difficulty paying the patient responsibility portion of their bill, please contact our billing department at 1-800-537-8378 and we will work with them to structure an appropriate payment plan based on their financial situation.