Lab Newborn Screening Payment Survey

As you may be aware, the 2017- 2018 General Appropriations Act, S.B. 1, 85th Legislature, Regular Session, 2017 (Article II, Department of State Health Services, Rider 37) requires the Department of State Health Services (DSHS) to study the most effective way to bill private insurers for newborn screening kits. The study must include the feasibility of requiring DSHS to bill private insurers for the cost of newborn screening kits and of requiring private insurers to automatically update their payment rates for the cost of newborn screening kits based on panel changes.

In an effort to assess potential barriers for healthcare providers and to gain information that will be vital to the success of the feasibility study, DSHS is requesting that newborn screening providers and other stakeholders respond to the following questions by April 15, 2018.

If you have any questions, please contact Rachel Lee at rachel.lee@dshs.texas.gov or 512-776-7158.

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* 1. What type of healthcare facility or provider do you represent?

Hospital

Birthing center

Multiple physician office

Single physician office/clinic

Midwife

Laboratory

Other (please specify)

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* 2. Do you collect newborn screens in your facility?

Yes

No (If no, skip to Question 17.)

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* 3. What type of newborn screening specimens does your facility primarily collect?

First screens (i.e. from infants less than 7 days of age)

Second screens (i.e. from infants 7 days of age or older)

Both First and Second screens

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* 4. Do you collect repeat newborn screens upon request (e.g. due to potential abnormal result of a previous screen)?

Yes

Don’t know

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* 5. Approximately how many newborn screens does your facility collect each month?

Less than 30

30-150

More than 150

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* 6. When you order newborn screening kits from DSHS, which types of kits are ordered?

Paid/self-pay kit only

Medicaid/CHIP/Charity kit only

Both

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* 7. On average, how many newborn screening kits are ordered each time you order?

1-25 kits

26-100 kits

101-500 kits

More than 500 kits

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* 8. Approximately, how often do you order newborn screening kits?

At least weekly

Monthly

Quarterly

Semi-annually

Yearly

Other (please specify)

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* 9. Do you file insurance claims for newborn screening sample collection procedure?

Yes

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* 10. Do you file insurance claims for cost of newborn screening kits?

Yes

No (If no, skip to Question 17.)

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* 11. Which CPT codes do you use to file insurance claims for the cost of newborn screening kits? (Select all that apply)

S3620

82016

82128

Other (please specify)

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* 12. What are the ranges of payment rates received from the insurance companies for CPT codes above?

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* 13. What is the approximate percentage of claims receiving any reimbursement from insurance company?

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* 14. What is the approximate percentage of claims receiving reimbursement less than the current Texas newborn screening fee of $55.24 from insurance company?

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* 15. If all required billing information is provided, how soon do you usually receive payments from insurance claims?

Less than a week

Within 1 month

Within 3 months

More than 3 months

Never

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* 16. DSHS updates the published newborn screening fee periodically to reflect the cost of testing performed. How do you update/negotiate payment rates accordingly? How long does the process take?

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* 17. Do you refer patients for newborn screening collection?

Yes

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* 17a. If yes, please select where the patient is referred to.

Hospital

Clinic

Laboratory

Other (please specify)

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* 18. If you have collected or are currently collecting newborn screens, have you ever stopped or considered stopping providing newborn screening?

Yes

N/A

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* 18a. If yes, please select why and select all that apply.

Cost of kits is a financial burden on my practice

Insurance doesn’t reimburse enough.

Insurance reimbursement process is too difficult or takes too long.

There is no one in my facility who can collect the newborn screen specimen.

Second screen is not needed.

Local hospital performs and saves my office staff time.

Other (please specify)

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* 19. If DSHS bills insurance directly for newborn screening (instead of billing healthcare providers), would it change the way you handle newborn screening in your practice?

Yes

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* 19a. If yes, please explain.

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* 20. Are there any challenges of the billing process specific for newborn screening? If yes, what are the biggest challenges?

Yes

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* 20a. If yes, what are the biggest challenges?

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* 21. To ensure all newborns in TX receive newborn screening, DSHS is considering a new process to request submitters to send in a blank Medicaid/CHIP/Charity kit when a parent refuses newborn screening, do you have any concern with this proposed new process?

Yes

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* 21a. If yes, please explain.

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* 22. Would you like to be contacted by the DSHS Newborn Screening Laboratory to discuss your facility’s billing issues?

Yes

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* 22a. If yes, please provide the following information.

Facility Name:

Contact Name:

Email or Phone #:

You will be redirected to the DSHS homepage, if your response is successfully received.

Click the "Submit" button below to submit your feedback.

(03/21/18)