Laboratory Compliance

Billing Policy

The University of Texas Medical Branch at Galveston, Department of Pathology, provides laboratory testing for a number of clients; inpatients at UTMB Hospitals, outpatients at the University Hospital Clinics, and non-patients for community physicians and other private clients.

In accordance with federal law:

  • UTMB Laboratories must bill Medicare, Medicaid, and other federally funded programs directly for laboratory tests.
  • UTMB Laboratories can not waive deductibles or co-payments required by any insurance company.
  • UTMB Laboratories can not provide professional courtesy laboratory testing services for physicians, their staff, or family members, as provided for in federal anti-kickback statutes.

Commercial Insurance/Patient Billing Options

UTMB Laboratories will bill commercial insurance companies/managed care plans or the patient, if requested by the physician's office and the appropriate information is provided on the requisition form. However, if billing information is not provided billing will automatically result in the generation of a Client bill.

Client Billing Option

UTMB Laboratories will bill the physician or client's office directly at the negotiated fee schedule. If there is not a negotiated fee schedule for a client, UTMB Laboratories reserves the right to bill the client at the laboratory's published price.

Information required on each requisition form:

Mandatory

  1. Collection Date and Time.
  2. Patient ID or medical record number.
  3. Print the patient name (Last name, First name, and MI).
  4. Sex
  5. Date of Birth
  6. ICD-9 Codes or Diagnosis
  7. Physician's name and UPIN number (or UTMB doctor number)
  8. Case ID or Financial Number (UTMB Patient Account Number). If not available or the patient is a non-UTMB Patient please provide the additional billing information below.

If any of the items above are not provided there may be a delay in receiving test results.

Billing Medicare/Medicaid or other federal programs.

UTMB Laboratories must bill Medicare, Medicaid, and other federally funded programs directly for laboratory tests.

Mandatory

  1. Insured/responsible party's name, street address, city state, zip code, and telephone number.
  2. Insurance company name, address, city state, zip code.
  3. Insurance company area code and telephone number.
  4. Group/policy number
  5. Member number

If the patient has a Case ID/Financial Number (UTMB Patient Account Number). The patient is registered in the UTMB Health Care Computer System, filling out this section is unnecessary.

Billing Commercial Insurance, or the patient

  1. Insured/responsible party's name, street address, city state, zip code, and telephone number.
  2. Insurance company name, address, city state, zip code.
  3. Insurance company area code and telephone number.
  4. Group/policy number
  5. Member number

If any of the items above are not provided there may be a delay in receiving test results and a bill will be sent to the physician's office or client.