Avera Laboratory Network

Through a strong network of laboratory services, we will strengthen the health services essential and vital to the physical and economic health of the people and communities in our region

Vision statement: We are committed to building productive and professional relationships that enable us to define and exceed individual customer needs, and to support our clients in their own delivery of service.

Service Overview:

Our locally owned and operated Avera LabNet Service Centers located in Aberdeen, Mitchell, Sioux Falls and Yankton offer comprehensive laboratory outreach services to physicians, hospitals, clinics, nursing homes and other providers requiring laboratory services in our five state region.

Our Service Centers are equipped with state-of-the-art methodologies and equipment to provide testing in all major clinical specialties. Test offerings are further enhanced through direct, quality relationships with nationally recognized laboratories specializing in esoteric laboratory testing.

Integrated, personalized, and caring services are the outstanding features of our Avera Laboratory Network. We acknowledge the importance of providing integrated services in our five state region but our services continue to emphasize our belief that each of our customers and the patients they serve, have needs that are unique and require individually structured services. Therefore, we strive at all times to personally customize our services to meet the needs of the customers we serve.

Professional Staff:

Avera LabNet�s Service Centers are quality driven by board certified pathologists. Our network of pathologists represent years of experience in all specialties of clinical pathology, cytology, anatomic pathology and nuclear medicine. Our pathologists serve as active clinical consultants and are available 24 hours a day for consultation on concerns related to appropriate test utilization, test result interpretive assistance or any concerns which may occur in the course of patient management.

In addition, our network takes pride in our dedicated clinical laboratory professionals which include directors, managers, consultants, technical staff and customer support staff whose combined education, experience and expertise assure quality through all pre-analytical, analytical, and post-analytical phases of laboratory and customer support services.

Customer Support Service Information:

Client Services:

Avera LabNet�s Client Service Representatives and Account Representatives take pride in serving our customers needs in a caring and effective manner.

Our Client Service Departments specialize in handling all client needs relating to:

Specimen requirements
Test result inquiries
Test availability assistance
Client communication needs
Specialized reporting requirements
Courier and supply assistance
Testing change assistance
Billing inquiries

We take pride in our Extended Client Service Coverage which is available 7 days a week, 24 hours a day to handle all our customers immediate assistance requests relating to direct testing information, specimen requirements and result inquiries.

Logistics:

Avera LabNet Service Centers provide regional courier services at no charge to our service areas in Iowa, Minnesota, Nebraska, North Dakota and South Dakota. Postal service and specialized contracted courier service may be utilized in areas outside of our direct service region.

Supplies:

All supplies specifically required in specimen requisition, preparation and transportation to our Service Centers are supplied at no charge. Supplies may be obtained by filling out a Supply Requisition and sending into your Service Center�s Client Service Department. Supplies include but may not be limited to:

Specimen transport bags, containers and separation tubes
Specialty collection kits and tubes
Requisitions and information forms
Reference catalogs and literature

Test Requesting:

Test requests may only be made by authorized individuals and may only be in written or system driven electronic format. Test requisitions preprinted with customer identification information will be provided at no charge to expedite written test requests.

Each specimen referred to our Service Centers must be accompanied by a completed test requisition form (written or electronically generated) that contains all required patient demographic, billing information, and test order information. In the event that incomplete required information is supplied, specimen testing and reporting may be held until the customer has been contacted for the information.

Telephone or verbal test requests will be accepted but do require that written authorization protocol be followed.

Reporting:

Test Turn-Around-Time (TAT) Guidelines:

Reporting TAT�s vary in the type of reporting chosen to specifically meet the individual needs of the customer. Mailed or hand-delivered reports may slightly increase the result TAT as compared to electronic or direct reporting mechanisms. The individual test listing section of this User�s Guide will give general guidelines as to when the analytical procedure is performed and then reporting will occur shortly thereafter. If testing results are needed and have not been final reported to the ordering customer, results may be obtained by calling your Service Center�s Client Service Department.

Critical Value Reporting:

When critical values are obtained during the testing process, Client Service or Technical personnel will call results directly to the ordering client or physician. In the event that critical values are obtained during hours or days when a client facility is not open, a phone call will be placed during the next available business day.

Critical values are also "flagged" on the test report, so in the event that reports are directly transmitted to facilities via faxes, printers, or electronic systems, it is the responsibility of the receiving facility to closely review the reports being received for critical values.

Specialized Reporting Requests:

To serve our customers individualized needs specialized reporting requests will be honored. It is the responsibility of the customer to clearly document on each test request complete instructions for the specialized reporting requested such as "call results to" or "copy results to".

Instructions must clearly identify the reporting specifics required and must include complete:

Name of facility, physician, or authorized individual to receive the report
Fax or phone number; or
Address, if results are to be mailed

Consultation Services:

Experienced consultants are available for administrative and/or technical consultative services. Services offered are structured to meet the individual clients needs at the frequency defined by the individual client and may include, but may not be limited to:

Review and recommendation on laboratory policies/procedures
Review and recommendation on quality processes and process improvement strategies
Performance of instrument validations and/or review of preventive maintenance programs
Continuing education
Review and recommendation on regulatory guidelines and accreditation standards
Assistance in general laboratory management accountabilities in the areas of purchasing, capital equipment, and personnel

Consultation services are charged for on an hourly fee for service basis and require a signed agreement outlining client requested services and frequency guidelines.

Policy Information:

Billing:

Avera LabNet Service Centers are established to perform various types of billing services. It is the responsibility of requesting facility to designate the appropriate type of billing required for the services rendered and to provide correct and complete billing information based on the type of billing to be performed. In the event, that the method of billing is not marked on the requisition or if incomplete billing information is provided, the client will be billed for the services requested.

Client Billing:

Itemized monthly statements will be issued. Terms of payment are net 30 days. If an invoice is in question, please contact your Service Center�s Client Service Department who may direct you to our appropriate Business Office personnel for assistance.

Clinic/Physician: Avera LabNet Service Centers are required to bill all tests performed on-site on Medicare and Medicaid patients. All other patient types may at the direction of the client be billed to their account.

Hospitals: Hospital clients are required to request Client Billing for all of their inpatient and outpatient laboratory services.

Medicare/Medicaid Billing:

Avera LabNet Service Centers will bill Medicare and Medicaid programs directly in accordance with all appropriate regulations. It is the responsibility of the submitting client to determine appropriate primary and secondary coverage specifics as required by federal law. All required test requisition information must be supplied at the time the test request is received. Required information includes but may not be limited to:

Patient�s specific demographic information (full legal name, sex, DOB)
Patient�s complete address
Medicare (or Medicaid) number(s)
Diagnosis information (ICD-9 Codes)
Requesting physician�s complete name (or last name, first initial)
Physician UPIN identification number if not previously on file at providing laboratory

In the event that incomplete information is given at the time of the test request, test processing, resulting and reporting may be held until the client has been contacted for the complete information required by federally funded programs.

Patient Billing:

Avera LabNet Service Centers will bill a clinic�s or physician�s patient directly if complete billing information is provided on the test requisition at the time the specimen is submitted. If you request that we bill the patient directly, please advise the patient to expect a bill from our laboratory. Required information includes:

Patient�s specific demographic information (full legal name, sex, DOB)
Patient�s complete address
Patient�s current phone number, including area code
Guarantor�s complete information (full name, address, phone number, relationship to patient)
Requesting physician�s complete name (or last name, first initial)

Third Party Billing:

Avera LabNet Service Centers will bill third party payors directly upon request. Complete billing information must be provided on the test requisition at the time the specimen is submitted. Required information includes:

Patient specific demographic information (full legal name, sex, DOB)
Patient�s complete address
Policy holder�s/Guarantor�s complete information (full name, address, phone number, relationship to patient)
Insurance company complete information (name, address, policy and group number)
Diagnosis information (ICD-9 Codes)

Compliance and Medical Necessity:

Avera LabNet Service Centers have adopted and implemented comprehensive Compliance Programs that enforce internal controls that promote adherence to applicable federal and state law and the program requirements of federal, state and private health plans. Through these formal programs, we are showing our commitment to the compliance process. We also remind all clients that they too are responsible by law to enforce and abide by rules and regulations relating to compliance regulations.

Medical Necessity and Diagnosis Codes:

The Medicare program will only pay for tests that meet Medicare coverage criteria and are reasonable and necessary to treat or diagnose an individual patient.
Organ or disease related panels will only be paid in whole when all components are medically necessary.
Medicare generally does not cover routine screening tests unless covered under approved screening program criteria.
It is the responsibility of the laboratory and the ordering physician or other authorized individual to ensure that claims being submitted for payment to federally funded programs occur only when services are covered, reasonable and necessary. Non-covered services must be identified as non-covered services through appropriate mechanisms.
It is the responsibility of the treating physician, authorized person on the physician�s staff or other authorized individual to order tests by law, to maintain in the patient record all required documentation to support the medical necessity of the service the laboratory has provided and billed to a federal or private health care program.

It is the responsibility of the treating physician, authorized person on the physician�s staff or other authorized individual to order tests by law, to provide at the time of the test request, all specific diagnostic information documenting the medical necessity of the tests requested. ICD-9 coding is the preferred format of providing diagnosis information. In the event that written diagnosis information is given, it must be in such format as to allow for direct conversion to an approved ICD-9 code. Inappropriate diagnostic information includes the use of abbreviations or truncated terminology. In the event, that written diagnosis information can not be coded, the appropriate individual will be contacted for diagnosis clarification.

Requisitions, Test Requests, and Panel Utilization:

Requisition mechanisms will be developed to capture required billing and compliance information. It is the responsibility of the requesting provider to complete all required information. In the event that required information is not provided at the time the test request is submitted, test processing, testing, and resulting may be held until the ordering provider has been contacted and the required information is obtained.
Physician�s and other authorized individuals are encouraged, whenever possible, to order individual tests specific to their patient�s clinical needs. Panel ordering is not encouraged.
Only AMA approved organ and disease specific panels will be offered.
Testing will only be performed with receipt of an appropriate written or electronic order. Any test order that is questionable as to which specific test is requested will be held until the ordering physician or authorized individual can be contacted to verify the order.
Physician�s and authorized individuals are reminded that the Office of the Inspector General (OIG) takes the position that an individual who knowingly causes a false claim to be submitted may be subject to sanctions or remedies available under federal law.

Clinical Consultation Services:

Clinical consultants, as defined by CLIA, are available at all Service Centers to provide guidance and consultation on utilization of reasonable and necessary testing. Clinical Consultant services are provided at no charge. Clinical consultants may be contacted by calling your Service Center�s Client Service Department.

Use of Advanced Beneficiary Notices (ABN's) or Waiver of Liability:

An ABN need only be obtained for laboratory testing that Medicare may deny as "not reasonable and necessary" upon submission of the claim. This includes testing for which Medicare has a Local Medical Review Policy (LMRP) that defines when the testing is determined by policy to be medically necessary.

When testing ordered is to be referred to a laboratory provider that will not see the patient or have the opportunity to obtain the ABN, the responsibility of obtaining the ABN form in correct format is the responsibility of the referring entity. The completed ABN form must be submitted at the same time that the test is requested and the specimen is sent into the laboratory for testing.

Criteria for an appropriately obtained and documented ABN includes:

The ABN must be in writing, using approved notice language.
A copy of the ABN must be retained by the laboratory providing services. Blanket waivers are not acceptable.
The ABN must be signed and dated by the beneficiary (or a person acting on the beneficiary�s behalf) prior to the service being provided.
The ABN must cite the specific service (testing) for which payment is likely to be denied.
The ABN must cite the physician�s specific reason(s) for believing Medicare payment will be denied. (The notice is not an acceptable waiver if it is no more than a statement to the effect that there is a possibility that Medicare may not pay for the service.)

Screening Tests:

An ABN should be obtained for payable screening tests if the service may be denied due to frequency limitations.

Routine screening services are services not covered by Medicare and do not require an ABN. ICD-9 code V82.9 (special screening of other conditions, unspecified condition) should be used to bill routine, non-covered screening tests performed in the absence of a specific sign, symptom, or complaint.

Non-covered Services:

An ABN is not needed for non-covered services under Medicare due to "statutory exclusion". As a courtesy, please inform your patient that the services are not covered by Medicare. The following service does not require an ABN as it is specifically excluded from the limitation of liability provision: Routine physician checkups (including lab tests furnished as part of the routine physical examination).

CPT Coding:

CPT coding references published by Avera LabNet are provided only as guidance to assist you in billing. The CPT codes listed reflect our interpretation of CPT coding requirements only and are subject to change any time. Avera LabNet assumes no responsibility for billing errors due to reliance on the CPT codes we publish. It is your responsibility to verify the accuracy of the codes provided and to assign values to each code based on the guidelines for your facility.

For further reference on CPT coding, please consult the CPT Coding Manual published by the American Medical Association, and if you have any questions regarding the use of the code, please contact your local Medicare carrier.

Confidentiality of Results:

Avera LabNet Service Centers strive to maintain the confidentiality of all patient information. To ensure the appropriate release of patient results in response to a telephone inquiry, one of the following may be required:

Specimen identification number
Client identification number
Name the person placing the verbal request and the phone number the results may be called to

Direct result transmission to a client�s facility via fax, printer, or electronic system is considered to be a confidential transmission. Client�s are requested to enforce appropriate confidentiality requirements on the receiving end.

Professional Courtesy Testing:

Federal and state regulations prohibit offering "professional courtesy testing"; therefore, we cannot honor requests for this service.

Referral of Testing to Other Laboratories:

Testing that is not completed within our Avera LabNet Service Centers is referred out to approved reputable, licensed reference laboratories. These laboratories are carefully selected on the quality and service that they provide. If a client requests that testing be sent out to another laboratory when the testing is either performed on site or is routinely sent to our approved reference laboratory, our Service Center will charge an additional processing fee to the facility requesting the special referral.

Release of Patient Information:

Testing results will only be released to authorized individuals. Patient results will automatically be reported to the ordering physician or authorized individual via the reporting mechanism established with the originating client facility. If patient results need to be reported to a secondary referring physician and/or facility, a written order must be received indicating where results are to be reported. Patient results will not be released to a secondary referring physician or facility without prior authorization by the primary ordering physician and/or facility.

Results will only be released to a patient when a written order to release information is on file from the ordering physician or authorized individual. Patients may also request release of their testing results by completing the appropriate "Medical Release Statement".

Repeat Testing:

Repeat testing determinations are performed routinely as part of Avera LabNet�s Service Centers ongoing quality assurance programs. This type of repeat testing is performed prior to the testing results being verified and reported.

If there are any questions relating to the validity of a result with respect to clinical findings, Avera LabNet Service Centers will be happy to repeat the assay at no additional charge. Please contact your Service Center�s Client Service Department and request that testing be repeated. You may also be asked to provide documentation as to why you wish to have the testing repeated.

Test Add-ons:

The Client Service Departments can arrange to do additional testing on specimens previously submitted for testing providing the following conditions apply:

Sufficient volume is available
Original specimen type is acceptable for additional testing requested
Specimen stability guidelines have not been exceeded
Additional testing requested does not require documentation that is not available and is required by federally funded programs (i.e. covered by Local Medical Review Policy)

Verbal orders received to request additional testing require following appropriate written authorization protocol.

Test Cancellations:

Avera LabNet Service Centers will accept requests for test cancellation received from the originating client prior to the testing being completed. The client will not be charged for the testing cancelled. The specific information relating to the test cancellation will be documented appropriately. Requests for test cancellation received after testing is completed cannot be honored; the test will be reported and the client will be charged appropriately.

Verbal Order Written Authorization:

Verbal orders for laboratory tests are permitted by Avera LabNet Service Centers only if the ordering physician or authorized individual agrees to complete written authorization for the test request within an acceptable time frame.

Avera LabNet Service Centers will issue a written authorization form to the ordering physician or authorized individual immediately upon receipt of the verbal order. The written authorization form must be completed and returned to the Client Service Department as soon as possible and receipt must be within 30 days. Faxing or electronic systems will be utilized to expedite the written authorization process. In instances where repeated delinquencies are documented in following acceptable protocol, verbal orders will not be accepted.

3900 West Avera Drive, Suite 100, Sioux Falls, SD 57108-5721
Questions? Please contact your Avera Laboratory Network Services Center.