A major element here is whether you are dealing with inpatients or outpatients. The payments for these two groups are structured very differently. In terms of outpatients, who we are often discussing when we look at fee-for-service and specific CPT-encoded billing, different institutions operate in vastly different manners. SOP used to be that the hospital collects the technical and the pathologists collect the professional component. However, if you look at what state Medicaid agencies pay for the TC vs the PC (subject of a paper of mine in press), you will see that the TC is often insufficient to cover even the cost of the test. Thus, "renegotiations" take place between the hospitals and the pathologists. It becomes very political at that point. Essentially...bottom line (literally)...there are no set rules here (just don't double bill for God's sake). Phil
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