Bill would regulate billing for patients' lab tests

By Margaret Stafford

KANSAS CITY — A bill before the Missouri House would prohibit doctors from marking up the cost of certain anatomical laboratory work — such as skin biopsies and Pap tests — that are performed by outside laboratories.

The bill, which has been approved by the Senate and is awaiting floor debate in the House, would prohibit what's known as "pass-through" billing.

That's when a doctor sends a patient's test sample to an outside laboratory for analysis. The lab charges the doctor a discounted price for the work, but the doctor bills the patient's insurance or the patient a higher amount.

The extra amount is profit for the doctor, and most patients don't even know what has happened.

"It seems to me that we should protect the patient from being charged (by a doctor) for a service that someone else is doing," said Rep. Kevin Wilson, R-Neosho, who is sponsoring the bill.

Opponents argue that the bill gets the state involved in pricing decisions that should be left to private practice physicians and could hurt services for some patients, particularly the uninsured.

The bill would require doctors or laboratories that actually perform the anatomical services to directly bill insured patients.

Doctors who send the tests to labs could bill uninsured patients for the services but could not increase the charges. The doctors would have to tell the uninsured patients who performed the pathology services and the cost.

Nineteen states have passed bills that either require direct billing or prohibit markup of pathological services. Medicare and Medicaid already have prohibited doctors from marking up the cost of the anatomical laboratory work they don't perform.

And the American Medical Association's code of ethics says no physician should be paid for a service that he or she does not perform, or charge a markup on services performed by others.

The law would reduce the potential for abuse even as doctors are ordering more tests than ever for their patients, said Dr. Joseph Lombardo, a pathologist who is medical director of hospital laboratories in the St. Charles area.

Lombardo said tests for skin cancer and prostate cancer, as well as procedures such as colonoscopies, had grown dramatically in the past 10 years.