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 laboratory 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, and physician
- Mark the box ACCOUNT BILL
If you fill out a requisition and request the testing laboratory 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/medical necessity information is required for all testing ordered
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.
ABN, or advanced beneficiary notice, 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
ABN’s are not required for routine or screening tests, as they are never covered services, but 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?
NCD and LCD reference information can be obtained from your regional service center web page.
What happens when Medicare denies payment for a submitted claim?
When a claim is denied, it is necessary to investigate the reason. The most common reason for denial is based on inadequate documentation. Your facility will be contacted to provide the necessary information. Oftentimes, a denial is based on inaccurate or incomplete diagnosis or miscoding.
Who do I contact with a billing question or concern?
If you have a question concerning billing, please contact your regional ALN 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 healthcare provider. If testing is being completed for screening or preventive purposes, this reason must be clearly identified.
How do I find out specimen requirements for a test that is not in the current catalog?
If you cannot find the information you need in the ALN online directory or on our website, please contact your ALN Service Center.
Who can I contact about a question on technical, regulatory or management issues relating to clinical laboratory science?
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 is intended to assist the clinical laboratory in developing effective internal controls that promote adherence to applicable federal and state law, and the program requirements of federal, state and local health plans. There are seven elements that a clinical laboratory needs to commit to in order to have an effective compliance program.
- development and distribution of written procedures and policies
- designate a chief compliance officer and participation on the corporate compliance committee is encouraged
- development and implementation of regular and effective training programs
- maintenance of a process to receive complaints
- development of a system to respond to allegations of improper/illegal activities and enforcement of disciplinary action against those who have violated internal compliance policies
- use of audits and/or evaluation techniques
- investigation and remediation of identified systematic problems
Of these seven elements, the first is of extreme importance. It can not be stressed enough the importance of documentation and recordkeeping. A laboratory should be able to produce or obtain documentation to support the medical necessity of the service they are providing and billing for. Laboratories are in a unique position to educate physician clients concerning medical necessity issues.
Billing is also an important part of the documentation process. It is imperative that the code used to bill accurately describes the service ordered and performed.
**For detailed information on Compliance issues contact a Technical Advisor/Consultant at one of the ALN Regional Service Centers.
How can I tell what billing will be completed when tests are ordered?
Refer to catalog, price list, or call client services.
What record keeping associated with ordering a test is my laboratory and my facility responsible for?
Individual laboratories must be able to produce, upon request, the documentation necessary to support medical necessity of the laboratory service provided and billed to federal or private healthcare programs. This documentation should come from treating physician, authorized person on physician’s staff, or other individual authorized by law to order tests. On Medicare, Medicaid and federally funded programs it is necessary to retain information regarding medical documentation, ABN’s, and billing. This documentation should be kept for up to 7 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 ALN Regional Service Center.
How do I obtain supplies for testing sent into Avera LabNet?
Complete and submit a 'Supply Requisition' to your assigned service center.
What types of supplies can I get through Avera LabNet?
Laboratory supplies needed for a specific laboratory test and specific to that endeavor will be supplied to you at no charge. These supplies include, but are not limited to, specialty collection tubes, transport tubes, culturettes, etc. Please contact your ALN Regional Service Center to assist you with your laboratory supply needs.
How do I determine if the specimen I have collected is acceptable for testing?
You should refer to your ALN online test directory for this information. If you cannot find what you need, contact your service center's Client Service department.