Insurance & Billing
Understanding our comprehensive services for insurance, billing and payment.
Billing
Because of our commitment to our customers, Boston Heart maintains an internal billing department to submit claims and invoice responsible parties by utilizing information provided by the client. Billing of service provided by Boston heart can be performed in the following ways.
Boston Heart is contracted with a variety of insurance payers throughout the United States (see In-Network Payers section below). We bill claims directly to the insurance company provided on the lab requisition. If insurance information is missing or invalid, we endeavor to obtain that information in a way that is least intrusive to your business. Therefore, we utilize a self-serve Client Billing Portal where clients can provide missing information, upload requested medical records, and pay client bill invoices. Please contact the Billing Department if you need access to this portal. After insurance adjudication, Boston Heart will only bill your patients for the responsibility left by their insurance company (deductible, coinsurance, or copay).
For patients without insurance coverage, Boston Heart will send a statement that is at the self-pay rate. At Boston Heart, we believe in compassionate, empathetic billing practices and we make every effort to work with our patients. There are options available to suit the patient’s need including payments plans and financial assistance based on income. For all options available we encourage patients to contact our team to find the best option suited for them. Our Patient Billing Support team is available weekdays from 10:00AM to 5:00PM ET to answer any patient questions. We also offer an Interactive Voice Response (IVR) tool and a self-serve patient portal that are available 24/7. If these options do not suit the patient, they are also encouraged to email our team directly at BHDbilling@bostonheart.eurofinsus.com. We make every effort to work with our patients and communication is the key to that endeavor.
Clients who choose the “Client Bill” option are invoiced directly for testing performed at Boston Heart. Our Billing Support team is available for any questions about your invoice. Any requisitions marked as “Client Bill” will go to the client, so it is imperative to correctly mark physician orders. Please visit the Client Billing Portal to access invoices, pay bills, and resolve billing issues. Please contact the Billing Department if you need access to this portal. Boston Heart follows Direct Billing laws.
How to Build a Successful Claim
To build a successful claim, our billing team requires certain information. This not only ensures successful payment of the claim, but also reduces the burden of asking the client to provide additional documentation. In addition, having the necessary information reduces time from date of service to patient bill (if any patient responsibility remains), which increases patient satisfaction. Please use the following checklist to ensure all required information is submitted.
- Patient Demographics: Please include name, DOB, patient mailing address, and phone number
- ICD-10 Diagnosis Code: A valid ICD-10 code must be provided. ICD10Data.com is a free web resource to search ICD-10 codes by narrative diagnosis. Your EHR will also usually have an integrated system to help you find the appropriate code.
- Ordering Provider: Ordering provider name and NPI must be provided. If your state does not allow advanced healthcare practitioners (nurse practitioners and physician assistants) to practice without a supervising physician, then please provide the supervising physician as well.
- Bill Class: Be sure to mark the bill class (Insurance, Self-Pay, Client Bill, etc.) so we can forward the bill to the appropriate payor.
- Insurance Information: Name of insurance company, member ID, group number (if applicable). When in doubt, include the facesheet from your EHR. This usually provides all the information we need for billing.
- Signature: Unsigned physician orders or unsigned requisitions alone do not support physician intent to order. Physicians should sign all order for diagnostic services to avoid potential denials.
- Documentation: Must support medical necessity when billing for ancillary services. The medical record must contain documentation that demonstrates that the testing is expected to influence treatment of the condition. To include: ordering provider, include (but not limited to) history and physical or exam findings that support the decision-making, problems/diagnosis, relevant data (e.g., lab testing, and results).
Commonly Used ICD-10 Codes
This information is provided as a useful reference tool and is not meant to suggest that any of these codes should or should not be used on any given occasion. This list is not a complete list, please refer to an ICD-10-CM manual or coding information on-line for a complete listing. Principle diagnosis should be listed first with additional codes for all documented coexisting conditions that affect patient care or management listed after the principle diagnosis. Boston Heart Diagnostics makes no recommendation regarding the use of any particular diagnosis code(s). For laboratory tests to be covered by third-party insurance to include Medicare and Medicaid, the medical records must contain enough information about the patient’s condition to support the medical necessity of the test.
Completing the Requisition
Use this as a guide to correctly complete the Boston Heart test requisition form. Required fields are highlighted in yellow. Requisitions that contain wrong or missing information will delay insurance claims.
Common Requisition Errors
ICD-10 codes are required on all requisitions to document the medical necessity of the services ordered. The medical necessity of each of the individual tests you request must be appropriately documented in the patient’s medical record as medically necessary and clinically indicated.
Current policy information must be submitted with the requisition regardless of whether it has been previously submitted. Often insurance information on file is outdated. Incorrect information results in a call to the office to resolve the issue.
Please indicate the correct option of billing on the requisition. Chose either client bill, insurance bill, or patient pay. If incorrect billing type is chosen a change of bill request needs to be submitted.
Any missing or discrepant patient information, such as DOB, gender and unclear names, will result in all tests being held until the provider’s office is contacted and the proper information is retrieved per CLIA requirements. Patient’s address must be provided if billing insurance.
Failing to properly and clearly order tests will result in delayed testing. Only after receiving confirmation of the test order from the provider’s office can the samples be processed for testing.
The ordering provider should be clearly indicated on each requisition. The report cannot be released until the proper authorized provider information is retrieved.
Results will be held until the specimen collection date is obtained.
In-Network Payers
Search the most recent list of in-network payers. Please note that this list is constantly being updated. If you don’t see the insurance company you are looking for, please contact our Billing Customer Care at: BHDbilling@bostonheart.eurofinsus.com
Patient Assistance Support Services (PASS)
Boston Heart’s Patient Assistance Support Services (PASS) program is intended to provide access to our testing services for all patients, regardless of their financial circumstances. Our PASS program has three components:
- Self-Pay Discount
- Payment Plans
- Financial Assistance
Approval for Financial Assistance must be obtained prior to submitting sample for lab testing.
Submit the completed Financial Assistance Application with current tax forms to pass@bostonheart.eurofinsus.com.
Frequently Asked Questions
The following features are available:
- View and pay invoices
- Dispute line items
- Upload documentation
- Resolve billing issues
Payments are reflected immediately when payed through the Client Billing Portal.
At this time most insurance companies do not cover genetic testing therefore we require the patients to pay a fee. Please refer to our fee schedule for current pricing.