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John Martinez

Solve Independent Diagnostic Testing Facility Billing Challenges with Practice Management Software

March 22, 2023

Biller, RCM 5 Minute Read

If you operate an independent diagnostic testing facility (IDTF), you’re aware of all Medicare billing requirements. Your facility must be separate from attending and consulting physicians, enrolled in Medicare Part B, and meet all standards to obtain and maintain Medicare billing privileges. As a result, you have unique billing obligations and needs. In this post, we’ll review what independent diagnostic testing facility billing is, what challenges it creates, and the benefits of using the right practice management platform.  

Why Are IDTFs Beneficial to the Healthcare Ecosystem?

As a response to the potential for non-coverage for hospital-based diagnostics, IDTFs expand the continuum of care, improve market competition, integrate with a system’s ambulatory care strategy, and offer flexibility outside hospital structures. They act as companions but are actually independent services, making IDTF billing much different from other types. 

What Is IDTF Billing?

IDTF billing captures how organizations code and charge for services and can include diagnostic services, technical components, and interpretative services. An IDTF bill must list all licensed physicians providing interpretations in accordance with the Medicare Claims Processing Manual. These clinicians must be Medicare enrollees, as well. 

How Does IDTF Billing Differ from Normal Billing?

IDTF billing involves different aspects outside standard billing, which can cause challenges. Here are some examples.

  • IDTF supervisory physicians cannot order IDTF-performed tests. Treating clinicians must first request, in writing, IDTF-performed procedures and specify the diagnosis or other reason for testing. The only exception to this rule is if the ITDF supervisory physician is also the patient’s treating physician.
  • Additionally, the IDTF cannot add any procedures without a written order from the treating physician. 
  • Therapeutic procedures are not billable items for IDTFs.
  • Slide preparation facilities and radiation therapy centers are not IDTFs. They must enroll separately with MACs (Medicare Administrative Contractors). 
  • Interpretation billing by a physician who doesn’t share a practice with the IDTF must meet specific criteria relating to anti-markup payment limitations defined in the Medicare Claims Processing Manual. 
  • Section 1877 of the Social Security Act limits certain physician referrals; if in violation, you’ll encounter denials of claims or demands for refunds.

What Are Some Specific Requirements for IDTF Billing?

Along with the differences noted above, IDTF billing has specific requirements. Here are some elements that fall into the category.

Electronic monitoring services billing 

Facilities that provide this service can perform some functions without seeing the patient. However, they must meet all IDTF requirements, which include a site visit by MACs. The MAC also must document a decision in writing that the entity has someone available 24-7 to answer inquiries by phone. Answering services are not acceptable.

Global billing

Global billing is allowable when the facility provides technical components and Modifier 26 codes, which are billing codes indicating that only professional services occurred. You can offer them in different locations if you supply them within the same MPFS, determined by ZIP code. 

Separate billing for technical and Modifier 26

IDTFs can submit these bills separately. Each claim requires the name, address, and National Provider Identifier (NPI) of the location delivering the services. 

POS codes 

Place of Service (POS) codes are frequently incorrect, according to CMS. The confusion relates to billing for non-face-to-face activities when providers interpret tests from a distant site. In this case, the POS code should be where the patient received the service. 

Skilled nursing facility transportation services for IDTF

Medicare can cover the transportation of a patient via ambulance for testing that a skilled nursing facility doesn’t have on-site. The patient must be a resident for approval under Medicare Part B.

Mammography services

IDTFs performing mammograms must have FDA certification to do so. Those only carrying out diagnostics for mammograms should not enroll as an IDTF.

Opioid treatment programs

Medicare allows enrollment for Opioid Treatment Programs (OTPs) as an IDTF. The program must have current, valid, and full certification by the Substance Abuse and Mental Health Services Administration (SAMHSA) and all its criteria, including Drug Enforcement Agency (DEA) registration, state licensure, and accreditation. 

With all these specific requirements, you can spend a lot of time and effort on IDTF billing. To minimize the complexity and streamline the process, practice management software with built-in IDTF billing requirements is a must.

ChartLogic Practice Management Software Includes IDTF Billing Requirements

You can eliminate many of the manual processes and errors of IDTF billing with the right practice management software. ChartLogic Practice Management includes many features that simplify workflows and enable you to increase revenue and decrease costs. IDTF is a core competency for the solution. Claims center functionality can reduce your rejections to less than 5 percent. You’ll also have access to various reports for billing. It also integrates with other applications in our suite, including EHR and Connect Patient Portal.

See how ChartLogic works for IDTF billing by requesting a live demo

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