What is a Pathologist?
A pathologist studies the nature and cause of disease. He or she is a specialist in diagnosing abnormal changes of surgically removed tissue. The word pathology originates from the Greek words pathema meaning disease, and logos meaning study. Medical clinicians depend on precise and timely results from pathologists to accurately diagnose and treat a variety of patient diseases.
Why am I getting a bill from Carolinas Pathology when I have never been there?
Your specimen has been referred to the physicians in our group (pathologists) for evaluation. Our pathologist prepares a report for your physician. We are happy to bill you or your insurance.
What are professional component fees?
These physician services may be billed by the pathologist to the patient (or the patient’s insurer) or to the hospital as the pathologist and hospital may agree. Medicare rules require pathologists to seek payment from the hospital for the professional component of clinical pathology services to Medicare patients because the hospital’s Medicare payment rate includes payment for these physician services. Pathologists and hospitals often negotiate a different billing arrangement for the pathologist’s professional services for non-Medicare patients.
The pathologist may bill a professional component for clinical laboratory services to the patient, and the hospital may bill the technical component. The hospital’s bill for the technical component covers hospital costs for laboratory equipment, supplies and non-physician personnel. When the pathologist bills a professional component to a non-Medicare patient, no payment is made by the hospital.
What are the professional components of clinical pathology services?
The performance of the professional components of clinical pathology services by pathologists involves the use of medical judgment and constitutes the practice of medicine. Although professional component clinical laboratory services are not the same type of face-to-face patient services that other physicians provide, these are actual medical services, which only pathologists are educated, trained and qualified to perform. Pathologists devote as much as 50% of their professional time to the professional component of clinical pathology services. These services contribute directly to the diagnosis, care and treatment of individual patients and the services can be performed only by physicians with specialized training. Professional component services are medically necessary services that are separate and distinct from the hospital's technical component of clinical laboratory services.
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