Anti-Markup Law Logic

A new anti-markup law was passed in Illinois for all Anatomical Pathology (AP). As a result, your clients may not be willing to support billing for AP services. The charges identified as Anatomic Pathology are from a variety of sources. Fusion provides two different sets of rules for billable party assignment including:

1. Rules for AP tests.
2. Rules for non-AP clinical tests.

Some of your clients may want to bill their non-AP clinical tests, client billing for you, and may want their AP tests to be billed by you, third party insurance. This is not possible with the interface dataflow as installed prior to Fusion v6.0. The anti-markup law became effective Jan 1, 2015.

 

Technical Details

Logic in the BDC is compliant with the anti-markup law and provides you with the ability to process billing files from other systems:

• Rule for AP tests. (Scrub 925)
• Rules for non-AP clinical tests. Some of your clients may want to bill their non-AP clinical tests, client billing for you, and may want their AP tests to be billed by you, third party insurance. (Scrub 925)
• Split Billing rules for clients. (Scrub 203)
  The split billing HL7 files are sent through your interface engine..

These rules provide the capability to classify and direct charges to the correct billing entity based on the following criteria:

• Client
• Payer
• Test Code
• Testing location
• Department
• Sequencing of priority of rules