Policies-Rockford Health Medical Laboratories (RHML).Fm

Policies—RockfordHealthMedicalLaboratories

(RHML)

AdvanceBeneficiary Notice(ABN) forMedicare

Coverage

TheCentersforMedicareandMedicaidServices(CMS)has establisheda standardizedABNthatensuresthatthe patient understandsthathe/shemayberesponsiblefor paymentifthe testisconsideredto bemedicallyunnecessaryby Medicare. TheABNidentifiesthelimitedcoveragelaboratorytest(s)and givesthereason(s)thetest(s)islikelytobedenied.Inorderfor thepatientto makeaninformeddecisionwhetherornotto receivethe service,theABNprovides2 options.

•Statesthatthepatientchoosesto havetheservice performedandunderstandsthathe/sheispersonally responsibleforpaymentintheeventMedicaredenies payment.

•Statesthatthepatientrefusesto havetheservice performedandwillnotifyhis/herdoctorofthatdecision. Ifa Medicarepatientseenat aRockfordHealthMedical Laboratory(RHML)patientservicecenterrefusesto signan ABN,theservicegenerallywillnotbe performed.

If reimbursementisdeniedduetolackofmedicalnecessity documentation,Medicarerulesprohibitthelaboratoryorhealth careproviderfrombillingthepatientunlessanABNhas been signedanddatedpriorto theservice.Asapplicable,anABN mustbecompletedeachtimeservicesare ordered.A blanket ABNis notacceptabletotheMedicareprogram.

Billing—CPT Codes

TheCPTcodespublishedinthisdirectoryareprovidedfor informationalpurposesonly.Thecodesreflectour interpretationof CPTcodingrequirementsandshouldbe individuallyassessedpriorto adoptionbyanyotherbilling agency.

CustomerService

Thecustomerservicespecialistscanprovideyouwith informationregarding:

•Specimenrequirements,includingspecialhandling procedures

•Testresults

•Statusoftestinginprogress

•Feesorbillingpolicies

•Availabilityof unlistedtests

•Proceduresforaddingteststo specimensthathave alreadybeenreceivedinthelaboratory

•Outpatientfacilities

PleasecallRHMLCustomerServiceDepartmentat815-971- LABS(5227).Yourquestionswillreceiveimmediateattention. Whennecessary,ourcustomerservicespecialistswillpromptly directyourcalltoamedicaltechnologistorto oneofour pathologists

CourierServices

Courierserviceisprovidedto ourclients.Wewilltailora scheduleto meettheindividualneedsofyouroffice.Weoffer STATpick-upandtesting.

CriticalValues

Criticalvaluesaredefinedastestresultsthatmaypresentalife- threateningriskto thepatientrequiringimmediate communication.Allcriticalvalueswillbecalledtothedirect caregiver(clinicallyresponsibleperson)assoonas the laboratorybecomesawareoftheresults.Theperson receivingtheresultisrequiredtoread-backthecriticalvalue result(s)andidentifythemselves.

Health InsurancePortability andAccountability

Act(HIPAA)

RHMLhasimplementedpolicies,processes,andprocedures designedtoensurecompliancewithHIPAA.

MedicareCoverage of Laboratory Services

Whenorderingteststhatare billedtoMedicare/Medicaid,the followingrequirementsapply:

•Onlyteststhataremedicallynecessaryfordiagnosisor treatmentofpatientshouldbeordered.Medicaredoes notpayforscreeningtestsexceptforcertainapproved procedures.A Medicarefee scheduleisavailableupon request.Medicaidreimbursementamountwillbeequal orlessthantheamountofMedicarereimbursement.

•Ifa testisconsideredmedicallyunnecessaryby

Medicare,thepatientmustbeinformedandmustsignan AdvancedBeneficiaryNotice(ABN)indicatingthathe orshewillberesponsibleforcostoftest(SeeAdvance BeneficiaryNoticeformoreinformation).Acopyofthe signedABNmustaccompanythespecimen.

•Alltestordersmusthavean ICD-9diagnosiscode,or

signandsymptomdescription.

•Organordiseaserelatedpanelsshouldbeorderedand billedonlywhenallcomponentsofpanelare medically necessaryandjustifiedbyICD-9code.

Releaseof Results to Patients

Itis preferredthattheorderingphysicianofficereleasepatient results.However,resultsmaybereleaseddirectlytothepatient ifthepatientsignsareleaseauthorizationformat oneofour patientservicecenters.PleasecontactourCustomerService Departmentat 815-971-LABS(5227)for moreinformation.

Reporting

Mostfrequentlyorderedtestsarecompletedand reported within24 hoursafterreceiptof specimensinourlaboratories. Thoserequiringlongertestingtimearereportedassoonas resultsareavailable.

RHMLusescomputerizedreportingsystemsincludingchart- readyprintoutswithageandsex-adjustedreferencerangesfor comparison.Formostprocedures,abnormalquantitativeresults are“flagged.”

Testresultsmaybedeliveredbyvariousmeans.Pleaseconsult withoursalesrepresentative.

•ElectronicReports:Allresultsaredisplayedinthe RockfordHealthSystemClinicalDataRepository (CDR).Manyclientswillreceiveresultsviaonline softwareintheiroffices.

•Telephone:Whentheclientspecifies“CallResults”in writingonthetestrequestform,orwhenlaboratory personneldeterminethattelephonedresultswillprovide optimalservice.(Printedresultsfollowwithregularly scheduledreportdeliveries.)

•TelecommunicationsFromOurCentralComputer: RHMLoperatesanetworkofremotetele-printers.We welcometheopportunitytoinstallaprinterin qualified clientlocationsto enableon-siteprintingofreports.

•First-classmail

•Facsimile:Pleasespecify“FaxResults”inwritingon thetestrequisition.

ScheduledTests

Thefollowingtestsmustbe scheduled:

•Sweatchloride

•Osmoticfragility

•Semenanalysis

PleasecallRockfordHealthLaboratoriesat 815-971-LABS (5227)toscheduleanappointment.

SpecimenLabeling

EachspecimenreceivedatRHMLiscarefullyinspectedfor properlabelingpriorto testing.To ensurespecimenintegrity, patientsafety,andadheretotherequirementsofvarious regulatoryandaccreditingagencies,itisessentialthatproper specimenlabelingproceduresbefollowed.Eachspecimen submittedfortestingmustbelabeledwiththefollowing information:

•Patientname

•Uniqueidentifiersuchasmedicalrecordnumber

•Date of birth

•Dateandtimeofcollectionandcollector’sinitials

•Culturespecimens,pleaseindicatesourceandsite (ie, source-wound,site-leftarm)

SpecimenRejection

Ourgoalistoensurethatallspecimenssubmittedtothe laboratoryareofthehighestqualityandarecollected,labeled, andtransportedinthe propermanner.Uponreceipt,each specimeniscarefullyinspectedforspecimenacceptability.The laboratoryreservestherighttorejectspecimens,whichmay affectthe qualityofresults.Reasonsfor specimenrejection, includethefollowing:

•Unlabeledorimproperlylabeledspecimencontainer

•Grosslyhemolyzedspecimen

•Specimenscollectedin theincorrecttubeorcontainer

•Specimensnotaccompaniedbythe propercompleted testrequestform

•Specimensnotcollectedwithproperpatientpreparation

•Specimensnotdeliveredtothelaboratorywithinthe requiredtimeframeoratpropertemperature

Ifa mislabeledorunlabeledspecimenisonethatcannotbe recollected(ie,spinalfluid,biopsyspecimen),thelaboratory willallowre-labelingby the personwhocollectedthe specimen.Inallothercases,theorderingphysicianofficewill benotifiedofthe specimenproblemorrejection.Thismay resultinreportingdelays.

Specimen Transport

Toassurethehighestqualityoflaboratorytesting,allspecimens shouldbedeliveredpromptlytothelaboratoryaftercollection. Pleaserefertospecifictransportinformationforindividual tests,includingallowabletransporttime,propercontainers,and temperature.Aconvenientcourierschedulewillbesuppliedto allclients.

Inordertofollowall federalandhealthsystemguidelines regardingpatientandworkersafety,all specimensmustbe transportedinapropermanner.Specimensmustbetransported ina tightlysealedcontainerwithnoexternalcontaminationor spillagewithinaclosedbiohazardbag.Centrifugedspecimens needtoremainuprightatalltimes.Thetestrequisitionshould beplacedinthe pocketof biohazardbag.

Standing Orders

RHMLwillacceptstandingorders,andtheywillbetracked electronically.Requiredinformationincludes:

•Dateorderiswritten

•Patient’scompletename

•Patient’sdateofbirth

•Patient’smedicalrecordnumber,if applicable

•Physician’sname

•Physicianssignature

•Test(s)

•Frequencyoftesting

•Test-specificICD9 codes

•Anyspecialinstructionsorotherpertinentinformation

•Stopdateif lessthanoneyear

Allstandingordersare onlyvalidforoneyearfromthedate orderiswritten.

Test Requisition

ManyRHMLclientsareabletosubmitorderstothelaboratory andpatientservicecentersviaonlinesoftware.Pleaseconsult theconnectivitysolutionmanualorcallourCustomerService Departmentforassistance.

Forclientswho do notutilizeonlineconnectivity,printed requisitionformsareavailableforroutineclinical,histological, andcytologicaltesting.Printedrequisitionformsareavailable bycallingourCustomerServiceDepartmentat815-971-LABS (5227).

Usingtheseformsensurestimelyandaccurateprocessingof yourorder,specimens,andresults.Ordersnotsentwiththe patientmaybeforwardedtoanoutpatientservicecenterbymail orfacsimile(see“LocationsandHoursofOperation”[p.4]for a listingofaddressesandfaxnumbers).

Pleaseincludethefollowinginformationonalltestrequisitions:

•Datespecimensareto becollected(includetimeif applicable)

•Forcollectedspecimens:

—Dateandtimeofcollectionandsourceofspecimen

—Patient’scompletename

—Patient’sgender

—Patient’sdateofbirth

—Patient’scompletemailingaddress

—Responsibleparty’s/insured’snameandaddressif otherthanpatient

—Orderingphysician’sname,address,andsignature

—Orderingphysician’sNPInumber

—ListallapplicableICD-9diagnosiscodestotheir highestlevelofspecificityforeachtestordered

—Completenameoftheinsurancecompanyand address

—Medicare,Medicaid,orinsurance/managedcare (HMO)insuredIDmembernumberasitappears ontheinsurancecard

—Group/policynumberasitappearsontheinsurance card(acopyof bothsidesoftheinsurancecard maybe provided)

Test TurnaroundTime

Turnaroundtimeiscriticalto patientcareandisanimportant componenttoourqualityassuranceprogram.Turnaroundtime istheintervalbetweenspecimenreceiptinthelaboratoryand resultsreporting.

STATTesting

•Wholeblood:<30minutes

•Plasma:<45minutes

•Serum:60minutes

•GramStain:<60minutes

•Rapidinfectiousantigentests:60minutes

Verbal Orders

Verbalortelephoneordersareallowedin situationsin which thepatientrequiresimmediatetreatment.Werequirethatall verbal/telephoneordersbegivento ourCustomerService Representativesat815-971-LABS(5227).Allverbaland telephoneorderswillbereadbackto thecallerforverification andaccuracy.Theseordersarefollowedup withalettertothe orderingphysicianrequestingwrittenauthorizationwithin30 daysoftheoralrequest.

Pleasephoneallverbalordersto ourCustomerService

Representativesat815-971-LABS(5227).