Florida Appeals Court Strikes Blow To Clinical Path Payment

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LEGAL ARGUMENTS SUPPORTING payment for clinical pathology professional services were dealt a blow when Florida’s Fifth District Court of Appeal issued an unfavorable ruling on July 12 in Daytona Beach, Florida.

“The import of the court’s ruling seems to be that a pathologist in Florida cannot bill a patient for clinical pathology professional services unless the pathologist has: 1) disclosed in advance the nature of these services to the patient; and 2) has obtained, in advance, written agreement from the patient to pay for these services,” stated Jack Bierig, Attorney at Sidley & Austin, a Chicago-based law firm representing the plaintiffs.

The Florida Society of Pathologists and two pathology groups had sued Central States to prevent it from communicating to patients that payments by patients for clinical pathology professional services were not appropriate. In August 2001, a Florida lower court ruled in favor of the plaintiffs. The defendants had then appealed this decision.

Reversed The Lower Court

“The District Court of Appeal’s ruling did not reflect an understanding of the services that pathologists perform for patients in directing the clinical laboratory,” stated Bierig, “At this stage, plaintiffs ask that the District Court of Appeal certify two items.

“First, that its decision conflicts with the prior decision of a Florida court. Second, that it involves a question of great public interest,” he explained. “Ultimately, the Florida Society of Pathologists and the two other plaintiffs can ask the state Supreme Court to review the case. The likelihood that it accepts this case would increase if the District Court of Appeals makes either of the two certifications we are requesting.”

Pathologists brought suit after Central States began to oppose clinical pathology professional component billing. Its opposition to the long-standing practice included sending letters to patients stating that: 1) such services were “unreasonable”; 2) that such payments were “double billing”; and 3) that no service to the patients was involved.

Path Money Under Attack

As THE DARK REPORT has noted regularly, clinical pathology professional component reimbursement is under attack in a variety of settings across the country. This trend is occurring even as the complexity of laboratory testing is growing, requiring clinicians to interact more frequently and in more depth with clinicians about the tests they order and how to best interpret the results.

Although it too early to judge the impact of this negative appeals court ruling, pathologists throughout the United States should pay close attention to this legal battle and lend their support. All trends in today’s healthcare system are consistent with a more intense role for clinical pathology professional services. The pathology profession should not lose its legal right to be paid for such services.

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