Client Billing Results in Lower Pathology Charge

WASHINGTON — Client billing may cost patients less than other forms of billing for pathology services, Manika Kumar and her associates said in a poster presentation at the annual meeting of the American Academy of Dermatology.

There is much debate about whether dermatologists should be allowed to bill patients directly for interpretations of skin biopsies done by pathologists. Nine states are considering laws to require direct billing from the physician who interprets the biopsy, while four states expressly prohibit any markup on pathology interpretations, according to Ms. Kumar and her associates of Wake Forest University, Winston-Salem, N.C.

The researchers surveyed North Carolina-based dermatology and pathology practices on skin biopsy practices and about billing for interpretation of those biopsies.

The researchers called 229 private dermatology practices, asking what they charged for interpreting biopsies, and whether those biopsies were interpreted in-office or sent out to pathologists.

The researchers also called 213 pathologists' offices to ask if they interpreted specimens from dermatology practices, and if so, how much they charged.

Of the 229 dermatologists, only 105 reported charges. Half of those 105 dermatologists could not give the exact charge because specimens were sent to pathologists who directly billed the patients. Of responding dermatologists, 9% interpreted skin biopsies in their office and directly billed the patient. Twenty-two percent sent the specimen to a pathologist but billed the patient for the interpretation—a practice known as client billing.

Client billing resulted in the lowest charge—a mean of $120. Patients who received a bill for interpretation by dermatologists on-site were charged an average $131. The most expensive charges were from pathologists who billed directly—a mean of $147, Ms. Kumar and her associates reported.

When pathologists were asked to report charges, only 48 of the 213 offices responded. The average reported charge was $150.

A Turkey-Kramer statistical test determined that the difference between client billing by dermatologists and direct patient billing by pathologists was significant. There was no significant difference between direct patient billing by dermatologists or pathologists, the investigators wrote.

Client billing is probably less expensive because dermatologists have lower billing costs and less risk of unpaid bills. Based on this small study, it is possible that Medicare and Medicaid payouts for pathology services could be reduced if the federal laws were changed to allow client billing for skin biopsies under those programs, Ms. Kumar and her associates suggested.