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Frequently Asked Questions
What information is mandatory on test requisitions?
The elements necessary on the test requisition vary depending on the type of
billing being done. If you are filling out a requisition for a client, or account, bill,
please include the name, date of birth, sex, date and time, test being ordered, and
physician. Be sure to mark the box ACCOUNT BILL, if you are completing a requisition for a
direct patient bill, you must include, name, date of birth, sex, date and time, test being
ordered and pertinent billing information, such as self-pay, patient insurance, Medicare,
or Medicaid. Diagnosis information is necessary on all requisitions.
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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 local Medical Review Policy and which has been
determined to possibly be denied for payment. A list of tests covered
under LMRP can be obtained from your regional service
center. For an ABN to be valid it must:
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Be in writing
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Be obtained prior to receipt of services
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Clearly identify the specific service which may be denied
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State that provider believes Medicare is likely to deny
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Give the provider’s
reason(s) for belief that Medicare may deny payment
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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. You must designate a
diagnosis of "screening or routine testing" on the requisition.
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How do I
get copies of current Local Medical Review Policies?
Local Medical Review Policies (LMRP) can be obtained from your Regional Service
Center.
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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:
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Aberdeen Service Center: (605) 622-5546 or 1-800-225-8537
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Mitchell Service Center: (605) 995-2342 or 1-800-995-5591
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Sioux Falls Service Center: (605) 322-7187 or
1-800-560-4846
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Yankton Service Center: (605) 668-8168
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What constitutes acceptable diagnosis information?
Diagnostic information must document the specific reason why the individual tests
are 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 preventative purposes, this reason must be clearly
identified.
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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
catalog or on our website, refer to the ARUP user guide or ARUP
website.
If you are
still unable to find the information you desire, such as specimen collection or handling
information, please call the ALN Regional Service Center nearest you.
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Who can I contact about a question on technical,
regulatory, or management issues relating to clinical laboratory science?
The dedicated, educated, and resourceful Consultant staff of
the Avera Laboratory Network can assist you with any and all of the issues regarding your
laboratory. These people stay abreast of the ever-evolving issues regarding laboratory
regulation and management. Each Regional ALN Service Center has access to a Consultant who
can meet your needs.
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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.
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development and distribution of written procedures and policies
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designate a chief compliance officer and participation on the corporate compliance
committee is encouraged
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development and implementation of regular and effective training programs
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maintenance of a process to receive complaints
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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
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use of audits and/or evaluation techniques
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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 Consultant at one
of the ALN Regional Service Centers.
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How can I tell what billing will be completed when tests
are ordered?
Refer to catalog, price list, or call client services.
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What recordkeeping 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.
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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. The Client Service
department can assist you with your needs.
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How do I obtain supplies for testing sent into 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, collection tubes, transport
tubes, culturettes, etc. Please contact your ALN Regional Service Center
to assist you with your laboratory supply needs.
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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, collection tubes, transport tubes, culturettes, etc. Please
contact your ALN Regional Service Center to assist you with your laboratory supply needs.
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How do I determine if the specimen I have collected is
acceptable for testing?
You should refer to your ALN catalog for this information. If
you cannot find what you need, always contact Client Services with specimen collection
questions.
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