Ambulatory Patient Group Reimbursement

IMPORTANT NOTE TO RADIOLOGY/LAB PROVIDER:

YOU HAVE BEEN DIRECTED TO THIS WEBSITE BY A REQUISITION FOR SERVICE THAT WAS ORDERED BY A HOSPITAL BASED CLINIC REIMBURSED BY APG (AMBULATORY PATIENT GROUP) METHODOLOGY. STATE LAW PROHIBITS YOU FROM DIRECTLY BILLING MEDICAID FOR THE TECHNICAL PORTION OF THESE SERVICES. YOU MUST BILL THE ORDERING CLINIC FOR THE SERVICES AND LOOK TO THE CLINIC FOR PAYMENT.

THIS NOTICE APPLIES TO LABORATORY SERVICES WITHIN THE 80000 RANGE, AND RADIOLOGY TECHNICAL SERVICES WITHIN THE 70000 RANGE. PROFESSIONAL CHARGES FOR RADIOLOGY SERVICES CAN BE BILLED DIRECTLY TO MEDICAID.

To be eligible for payment from Strong Memorial Hospital or Highland Hospital you must agree to the following:

1. You will provide the service and furnish the test results to the ordering provider at the address on the front of this requisition within 30 days of the date the service was ordered.
2. You will bill Strong Memorial Hospital or Highland Hospital for the technical portion of the service at the address below within 30 days after you provide the service, after verification of Medicaid coverage on the date of service. Please provide patient name, date of service, ordering provider, cpt4 code for the service billed, and CIN # of patient to assure appropriate identification. You will not bill Medicaid for the technical portion of the service.
3. You will not bill or collect anything from the Medicaid enrollee for the technical portion of the service except for permitted co-payments. The only exception to this is if the patient was not enrolled in Medicaid when the service was provided.
4. You will comply with all applicable state and federal laws, regulations, Medicaid manuals, Medicaid updates and other applicable guidelines in performing this service.
5. You will pay us any amounts we have to pay to Medicaid within 10 days of our demand to you for repayment, if we are audited and it is determined that the services you provided must be disallowed, or if you billed Medicaid for services that were included in the payment we received from Medicaid.
6. You will indemnify us for any liability, loss or payment we incur as a result of your breach of any provision of this Agreement.
7. We will pay you at the Medicaid fee schedule rate applicable to services performed by your type of provider (hospital, physician office, etc.). You will accept this payment as payment in full.
8. We will pay you within 30 days after Medicaid pays us for the service you provided if you have furnished the test results to the ordering provider and are otherwise in compliance with this agreement.
9. We will have no obligation to pay you for the service if Medicaid denies payment to us for the service you provided.

Providing the tests ordered on the requisition constitutes agreement to the terms and conditions set forth above. This is the complete agreement between the parties. It may only be amended by a writing signed by both parties.

For laboratory services provided to Strong Memorial Hospital APG patients, as indicated on their requisition, please send the bill to:
University of Rochester Clinical Labs
APG Ancillary Billing
601 Elmwood Ave Box 608
Rochester, NY 14642-5677

For radiology technical services provided to Strong Memorial Hospital APG patients, as indicated on their requisition, please send the bill to:
Strong Memorial Hospital
PAO - APG Ancillary Billing
601 Elmwood Ave.   Box 684
Rochester, NY  14642-5677

For laboratory services, or radiology technical services provided to Highland Hospital APG patients, as indicated on their requisition, please send the bill to:

Highland Hospital
Attn: APG Billing
1000 South Avenue - Box 76
Rochester NY 14620