March/April 2001
EDITOR'S NOTES
For those of you with teenagers, you know that the winter sports is over and track practice has begun. In my town of Dell Rapids, tracksters running amidst snow drifts is the first sign of the forthcoming spring. How we love the upper midwest! (The winter cartoon in this issue reflects how we are feeling about winter now.) Lent is in full force and you know that if we have 75 inches of snow on Ash Wednesday, we will surely have snow on Easter Sunday! (O.K., so I exaggerate).
With April also comes National Laboratory Week. Please take time to show your appreciation for your co-workers in the lab. If your lab is doing something creative/unique, please let us know and we can include it in our next issue.
In May and June, ALN will have booths at numerous clinical laboratory shows and conferences. We will have a booth at the SDSCLS/CLMA convention on May 9-11 in Aberdeen. Be sure to stop by and visit if you get the opportunity to attend any of these events.
When the days get warmer, get out and enjoy the weather. Have a blessed Easter.
Pam Hegge
HEMOCHROMATOSIS
Hereditary hemochromatosis is an autosomal recessive defect in the ability of the duodenum to regulate iron absorption; abnormal gene present in 10% of white Americans; frequency of homozygosity >3 in 1000.
1-3% of heterozygotes develop iron overload, may be due to coincidental condition with altered iron absorption or metabolism.
Lab tests to confirm.
Lab findings due to involvement of various organs:
Lab findings due to complications:
Adequate treatment with phlebotomy (1-3 Units/week) sufficient to maintain a mild anemia is determined by Hct (37-39%) before each phlebotomy. If >40%, an additional treatment may be scheduled. Maintenance phlebotomy
(4-6 Units/yr). Removal of 450-500 mL of blood causes loss of 200-250 mg of iron.
MANAGEMENT CHANGES AT AVERA QUEEN OF PEACE LABORATORY
As of February 24, 2001 Ron Johnson is the lab manager at Avera Queen of Peace. Bonnie Fuerst will be overseeing the day to day routine of the laboratory. Vicki Lehrman will continue in her role as Outreach manager and technical consultant. Along with the outreach work,
Vicki will be devoting her time to Corporate Compliance and Safety.
OSHA RELEASES FINAL NEEDLESTICK SAFETY REGULATIONS
According to OSHA, by April 18, hospitals will have to have a plan for safe needle devices
to protect employees form sharp injuries. OSHA released its revisions to its bloodborne pathogen standard on January 18, 2001. (29 CFR Part 1910)
OSHA estimates that 5.6 million workers in the health care industry and related occupations are at risk of occupational exposure to bloodborne pathogens. According to the CDC in March of 2000, it estimated that 600,000 to 800,000 needlestick or other
subcutaneous injuries occurred annually among healthcare workers.
These revisions require hospitals to solicit frontline employee input in choosing safer sharps devices.
It also requires a log to be maintained which tracks needlesticks, rather than only recording sharps
injuries that actually lead to an illness.
To view the rule or for more information, visit http://www.osha.gov
COMPLIANCE RELATED QUESTIONS & ANSWERS
If the authorizing physician orders several tests that fall within an automated test panel, but one short, can the lab bill Medicare for the entire panel?
No. A laboratory may only bill for tests performed in response to a physician's order, even if the tests ordered fall short of an automated test panel. Under Medicare rules, a lab need no longer bundle automated tests for billing purposes. The Medicare contractor has been instructed to do the proper bundling when processing a claim for payment. If a physician orders an automated panel plus additional tests, the lab may bill individually for all the tests or may bill the panel code plus the appropriate codes for the additional tests. For example, if a physician individually orders ALT, AST, albumin, alk phosphatase, total and direct bilirubin, protein, and potassium, the lab may bill for a hepatic function panel (CPT 80058) and an individual potassium test (CPT 84132).
Can our physician office lab (POL) take advantage of Medicare's lab-to-lab referral exception?
No, this exception is available only to hospital and independent labs. (Medicare Carriers Manual, Section 5114.1E). Under this Medicare policy, when one lab refers work to another lab, the referring lab may under specified conditions bill for testing that the other lab performs. However, so long as the testing is being billed under the Medicare number of either the physician or his or her group practice. Medicare requires that such testing be performed or supervised by the physician or someone else with whom the doctor share the practice. When POL testing is referred to another lab, the performing lab must always bill for the testing. Such testing may never be billed back to the POL, then billed to Medicare by the physician or group practice. Reminder: For hospitals covered by Medicare's lab-to-lab exception…Medicare requires you to always bill for testing for inpatients and outpatient which has been referred to an outside lab.
When billing a Medicare patient for a laboratory test on the basis of a valid ABN, must the lab bill at what the government allows for the test under the lab fee schedule?
No. The patient should be billed at the lab's usual charge. The basic rule to keep in mind is that the lab should charge the patient whatever it had charged Medicare. In fact, the HCFA has publicly stated that the lab is not required to bill the patient the Medicare allowable (amount that would have been paid by Medicare). Specifically, agency officials have stated in correspondence, "In the normal circumstance where the laboratory has received an ABN and a service is denied for payment, the lab has the right to bill its "usual charge for the services to the beneficiary."
NATIONAL MEDICAL LABORATORY WEEK
There are approximately 300,000 practitioners of clinical laboratory science in the United States. Since the development of the career in the 1920's, the clinical laboratory science profession has played an increasingly vital role in the diagnosis and prevention of disease. Today, clinical laboratory professionals are key members of the health care team.
The celebration of National Laboratory Week helps to increase recognition for the profession, as well as improve the individual practitioners' sense of self-worth. The sense of unity and purpose that National Laboratory week symbolizes helps to further the goals of all laboratorians.
The Avera Laboratory Network salutes all medical laboratory professionals for their vital contributions to the healthcare team. We recognize you and thank you for your role in patient care and dedication to your profession. Happy Lab Week !!
MORE INSURANCE INFORMATION NEEDED ON AMRL REQUISITIONS
Many insurance companies have multiple carriers in different cities. Hence, an insurance company can have more than one address. For this reason, we request that more insurance information be given on the lab requisitions. Fully copy the information on the patient's insurance card onto the lab requisition
(including the insurance company's address) or send
a copy of the patient's insurance card with the AMRL requisition. Your cooperation will be greatly
appreciated!
CLIENT SERVICE SPOTLIGHT
Sherri Janzen has been a Client Service Representative/MLT at Avera McKennan for the past year. She graduated from Presentation College with an Associate Degree
of Science and is a member of NCA. Sherri and her husband, Glenn, have a son, Alexander, age 21 months. Sherri's interests include stamping, camping and hiking.
SDSCLS/SIOUXLAND CLMA STATE MEETING
May 9-11, 2001 o Ramkota Inn, Aberdeen, SD
Keynote speaker - Cheryl Kraft: "Who's Managing Whom? Generational Differences:"
Following is a list of some of the topics to be presented:
o Shipping of Hazardous Materials-HAZMAT Training for the Lab
o Hematology Case Studies
o OSHA Standards & Safe Needle Devices
o Basic Care of the Microscope
o New Thin Layer Technology in Pap smears
o Ergonomics in the Work Place
o Tai Chi Flow Movement
o Compliance Education for Physicians: "What's in it for me?"
o Influenza/West Nile Virus
o Hormones in Natural Family Planning
o Microbiology the Most Wanted List: "Emerging Resistance"
o The Internet and the Laboratory
o Basic Instrument Troubleshooting
o CLIA Update by Judy Richards
o Alternative Treatment for Menopause
o How We Learn: "The Biology of Memory"
o Updates in Blood Bank: "Questions you never thought to ask"
o Humor in the Workplace
Mark your calendars now. More program information and registration will be mailed by the middle of March.
A block of rooms have been reserved at the Ramkota Inn in Aberdeen.
Phone number: (605)-229-4040. Make your reservations early.
AVERA QUEEN OF PEACE SERVICE CENTER IS CURRENTLY PERFORMING THIS TESTING
IN-HOUSE:
Ferritin: Specimen is serum, specimen needs to be frozen if not run within 24 hours of time of collection
Folate: Specimen is serum, specimen needs to be frozen if not run within 24 hours of time of collection.
Vitamin B12: Specimen is serum, specimen needs to be frozen if not run within 24 hours of time of collection
Ferritins, Folates, and B12's are run Monday thru Friday after 2p.m.
Urine Microalbumins:† Specimen is either 2nd morning random urine or 24 hour urine specimen. Collect urine without additives and refrigerate during collection. These are run 7 days a week when needed.