There is typically confusion amongst the nurse practitioner business owner when it comes to obtaining lab work from patients in a cash-based practice. Sometimes there is confusion on how to do it in an insurance-based practice as well, so this article is going to briefly go over how to order lab work correctly in the nurse practitioner practice and also how to charge for it if you are going the cash route.
First, let’s go over charging the patient for lab work. You can either charge them cash or have insurance pay for it. This is a relatively straight forward:
- If you are charging cash for the lab work, then you need to negotiate cash prices for the labs through a local laboratory or through pre-negotiated rates (like the Elite NP discounted prices through Access Medical Labs). The lab will charge your clinic for the lab panels and then you charge the patient whatever you want. The markup is generally 2-3x, therefore it can create a healthy profit margin.
- If you are having the patient use their insurance for the lab work, then you simply give them an order and have them go to a lab. The lab will take care of the insurance billing. YOU DO NOT NEED TO WORRY ABOUT THIS. Just give them an order and be sure to include a few ICD10 codes on the order. Words of caution: Sometimes insurance companies WILL NOT pay for lab work for many niche service lines (HRT, weight loss, etc..). They are not considered a medical necessity. So, warn the patients that insurance might NOT pay for their labs and that your practice is NOT responsible for huge bills. This is the time that you try to convince them to pay the cheaper cash negotiated rates just FYI 😉 It can prevent $1000+ bills for the patient.
In terms of obtaining labs, when you are an employed nurse practitioner, you just put an order for lab work in the EMR and walk away. There is little thought behind it. This is different for the nurse practitioner entrepreneur though because you must figure out the PROCESS on how this works. Luckily, it is straight forward.
There are 3 options in terms of lab acquisition in your practice:
- You draw the labs in your office or in the patient’s home (if mobile).
- You send a lab order to a local lab and have the patient go there to obtain the lab work.
- You give the order to the patient, and they can go anywhere they want.
It is that simple! Let’s talk about some pros and cons with each option.
If you are drawing the labs in your office or the in the patient’s home, then you need to factor in the labor component. Drawing lab work, spinning it down, and sending it to the lab can be burdensome and time consuming (especially if you are operating a solo practice). This is what I call BUSY WORK. So, you need to factor in the time cost with drawing labs in your office. The biggest benefit of doing this though is that you can charge the patient a lab draw fee (or bill their insurance) and if you are charging cash for the lab draw, then you can maximize your returns. If you use the discount lab packages that I have negotiated with Access Medical Labs for Elite NP members (link here), then it is best to draw in house. This will negate the fee that other labs will charge you for the lab draw.
If you are going to send the lab order to a local lab, then you don’t have to worry about the labor component. All you do is just fax the order or send the order electronically to the lab of your choosing. When the patient arrives, they should be able to check in and get the lab work done. Once the labs are processed, the lab then should fax or email you the results. The keywords here are “should.” This is how it “should” work, but labs are notorious for not receiving orders or forgetting to send you the results. The pro here is that if the patient is using their insurance, then the lab will collect their insurance information at check in and deal with that entire process for you. If you have negotiated cash rates with this lab, then they will just draw the labs and bill you later for them. Typically, the labs won’t charge you a draw fee if you have an established account with them.
The 3rd option is by just giving the patient a lab order and have them go wherever they want. This is the best way to do it if they are using their insurance in my opinion. You can either email the patient the lab order or have them come into your practice and pick it up. Then they can go wherever they want, whenever they want. This works great for telemedicine practices. A pro with this option is that it prevents the “we never received the lab order” problem that happens with labs and if the patient is using insurance, then the lab will deal with that. The downside is cash rates. For a lab to charge patients a decent cash rate, it needs to be negotiated between the lab and the clinic. Therefore, if the patient goes to a lab where you don’t have negotiated rates, they will be charged an arm and a leg for the lab work.
So, keep this simple! My preferred route of doing this is to have the patient come into the office for the lab draw if I am charging them cash or just handing them an order if they want to use insurance. I have 2 lab accounts for cash pay: one with Access and one with a local lab. So, if my men’s health practice is really busy and we don’t have time to draw the labs in house for a cash patient, then we just hand the patient the order and tell them to ONLY go to the lab we negotiated rates with. Piece of cake!
If you need cash-based lab pricing, use Access Medical Labs or call an account representative at a lab in your area to negotiate rates! It is a straight forward process.