Find out more about the Avera Laboratory Network with these answers to frequently asked questions.
What information is mandatory on test requisitions?
The elements necessary on the test requisition vary depending on the type of billing requested. If you fill out a requisition and request the testing lab to bill services to your facility (bill account), please include:
- Patient full legal name
- Date of birth
- Sex
- Date and time
- Test(s) being ordered
- Physician
- Mark the box "account bill"
If you fill out a requisition and request the testing lab to bill the patient (insurance, Medicare, Medicaid, self-pay) for the services, you must include:
- All patient demographic information listed above
- Patient complete address
- Guarantor and insurance/Medicare/Medicaid coverage information
- Diagnosis and medical necessity information (required for all testing orders)
When must an ABN be completed?
Medicare will only pay for services that it determines to be reasonable and necessary. Every attempt must be made by the ordering physician, nursing staff and laboratory staff to document medical necessity to ensure reimbursement from Medicare.
Advanced beneficiary notice (ABN) must be completed for testing covered under a national or local coverage determination (NCD or LCD) and which has been determined to possibly be denied for payment. A list of tests covered under NCD and LCD can be obtained from your regional service center.
For an ABN to be valid it must:
- Be in writing
- Be obtained prior to receipt of services
- Clearly identify the specific service which may be denied
- State that provider believes Medicare is likely to deny
- Give the provider's reason(s) for belief that Medicare may deny payment
- Have the beneficiary mark one option indicating their choice to have testing performed or not
- Have the beneficiary sign and date form
ABNs are not required for routine or screening tests, as they are never covered services. Even with this being the case you are encouraged to inform your clients via an ABN. The provider must designate a diagnosis of "screening or routine testing" on the requisition.
How do I get copies of current coverage determinations?
You can find NCD and LCD reference information on your regional lab network service center web page.
What happens when Medicare denies payment for a submitted claim?
When a claim is denied, it is necessary for your facility to investigate the reason why it was denied. The most common reasons for denial are inadequate documentation, miscoding or an inaccurate or incomplete diagnosis.
Your facility will be contacted by Avera lab network staff to provide the necessary information or accurate documentation.
Who do I contact with a billing question or concern?
If you have a question concerning billing, please contact your regional lab network service center. Contact information can be found on each service center page.
What constitutes acceptable diagnosis information?
Diagnostic information must document the specific reason why each individual test is being ordered. Reasons may include a previously diagnosed disease or signs and symptoms relating to why the patient is being seen by a health care provider. If testing is intended for screening or preventive purposes, this reason must be clearly identified.
How do I find specimen requirements for a test not in the catalog?
If you cannot find the information you need in the ALN online directory or on our website, please contact your lab network service center. Contact information can be found on each service center page.
Who can I contact about clinical lab technical, regulatory or management questions?
Our staff can assist you with issues regarding your laboratory, including those involving laboratory regulation, technical quality and management. Each regional service center has access to a consultant who can meet your needs.
What are a laboratory's main responsibilities in a compliance program?
A compliance program helps a clinical laboratory set up internal controls to meet applicable federal and state law, and program requirements of federal, state and local health plans.
For a compliance program to be effective, it should include these elements:
- Clearly written procedures and policies
- Designated chief compliance officer and participation in a corporate compliance committee is encouraged
- Effective and ongoing training programs for staff
- Established process for receiving complaints
- Regular audits and/or evaluation techniques
- System for handling misconduct and enforcing disciplinary actions for those who violate compliance policies
- Thorough investigation and correction of identified issues
Strong documentation is critical for accurate recordkeeping. A laboratory should be able to produce and obtain documentation of billed services to show medical need. Labs play a part in educating clients concerning medical necessity requirements.
Billing is also important. The code used to bill must accurately describe service ordered and performed.
How can I tell what billing will be completed when tests are ordered?
Refer to the catalog, price list or call client services.
What test ordering recordkeeping is my laboratory and my facility responsible for?
Individual labs must be able to provide documentation, upon request, showing that a billed service to federal or private health care programs was medically necessary. This information should come from the ordering physician or an individual legally authorized to order tests.
For Medicare, Medicaid and other federally funded programs, labs must retain medical records, billing details and ABNs. This documentation should be kept for up to seven years to meet compliance standards.
Who do I contact about courier problems or special courier needs?
If you have questions regarding specific courier needs or comments on current courier service, please call your lab service center.
What types of supplies can I get through Avera Lab Network?
We will provide supplies needed for a specific laboratory test no charge. These supplies include, but are not limited to, specialty collection tubes, transport tubes, culturettes, etc. Please contact your lab service center for help with laboratory supply needs.
How do I get supplies for testing sent to Avera Lab Network?
Complete and submit a “Supply Requisition” to your assigned service center.
How do I determine if my collected specimen is acceptable for testing?
You should refer to your lab network online test directory for this information. If you cannot find what you need, contact your lab service center.
