Policies—Rockford Health Medical Laboratories
(RHML)
Advance Beneficiary Notice (ABN) for Medicare
Coverage
The Centers for Medicare and Medicaid Services (CMS) has
established a standardized ABN that ensures that the patient
understands that he/she may be responsible for payment if the
test is considered to be medically unnecessary by Medicare.
The ABN identifies the limited coverage laboratory test(s) and
gives the reason(s) the test(s) is likely to be denied. In order for
the patient to make an informed decision whether or not to
receive the service, the ABN provides 2 options.
• States that the patient chooses to have the service
performed and understands that he/she is personally
responsible for payment in the event Medicare denies
payment.
• States that the patient refuses to have the service
performed and will notify his/her doctor of that decision.
If a Medicare patient seen at a Rockford Health Medical
Laboratory (RHML) patient service center refuses to
sign an ABN, the service generally will not be
performed.
If reimbursement is denied due to lack of medical necessity
documentation, Medicare rules prohibit the laboratory or health
care provider from billing the patient unless an ABN has been
signed and dated prior to the service. As applicable, an ABN
must be completed each time services are ordered. A blanket
ABN is not acceptable to the Medicare program.
Billing—CPT Codes
The CPT codes published in this directory are provided for
informational purposes only. The codes reflect our
interpretation of CPT coding requirements and should be
individually assessed prior to adoption by any other billing
agency.
Customer Service
The customer service specialists can provide you with
information regarding:
• Specimen requirements, including special handling
procedures
• Test results
• Status of testing in progress
• Fees or billing policies
• Availability of unlisted tests
• Procedures for adding tests to specimens that have
already been received in the laboratory
• Outpatient facilities
Please call RHML Customer Service Department at 815-971LABS (5227). Your questions will receive immediate attention.
When necessary, our customer service specialists will promptly
direct your call to a medical technologist or to one of our
pathologists
Courier Services
Courier service is provided to our clients. We will tailor a
schedule to meet the individual needs of your office. We offer
STAT pick-up and testing.
Critical Values
Critical values are defined as test results that may present a lifethreatening risk to the patient requiring immediate
communication. All critical values will be called to the direct
care giver (clinically responsible person) as soon as the
laboratory becomes aware of the results. The person
receiving the result is required to read-back the critical value
result(s) and identify themselves.
Health Insurance Portability and Accountability
Act (HIPAA)
RHML has implemented policies, processes, and procedures
designed to ensure compliance with HIPAA.
Medicare Coverage of Laboratory Services
When ordering tests that are billed to Medicare/Medicaid, the
following requirements apply:
• Only tests that are medically necessary for diagnosis or
treatment of patient should be ordered. Medicare does
not pay for screening tests except for certain approved
procedures. A Medicare fee schedule is available upon
request. Medicaid reimbursement amount will be equal
or less than the amount of Medicare reimbursement.
• If a test is considered medically unnecessary by
Medicare, the patient must be informed and must sign an
Advanced Beneficiary Notice (ABN) indicating that he
or she will be responsible for cost of test (See Advance
Beneficiary Notice for more information). A copy of the
signed ABN must accompany the specimen.
• All test orders must have an ICD-9 diagnosis code, or
sign and symptom description.
• Organ or disease related panels should be ordered and
billed only when all components of panel are medically
necessary and justified by ICD-9 code.
Release of Results to Patients
Specimen Labeling
It is preferred that the ordering physician office release patient
results. However, results may be released directly to the patient
if the patient signs a release authorization form at one of our
patient service centers. Please contact our Customer Service
Department at 815-971-LABS (5227) for more information.
Each specimen received at RHML is carefully inspected for
proper labeling prior to testing. To ensure specimen integrity,
patient safety, and adhere to the requirements of various
regulatory and accrediting agencies, it is essential that proper
specimen labeling procedures be followed. Each specimen
submitted for testing must be labeled with the following
information:
Reporting
Most frequently ordered tests are completed and reported
within 24 hours after receipt of specimens in our laboratories.
Those requiring longer testing time are reported as soon as
results are available.
RHML uses computerized reporting systems including chartready printouts with age and sex-adjusted reference ranges for
comparison. For most procedures, abnormal quantitative results
are “flagged.”
Test results may be delivered by various means. Please consult
with our sales representative.
• Electronic Reports: All results are displayed in the
Rockford Health System Clinical Data Repository
(CDR). Many clients will receive results via online
software in their offices.
• Telephone: When the client specifies “Call Results” in
writing on the test request form, or when laboratory
personnel determine that telephoned results will provide
optimal service. (Printed results follow with regularly
scheduled report deliveries.)
• Telecommunications From Our Central Computer:
RHML operates a network of remote tele-printers. We
welcome the opportunity to install a printer in qualified
client locations to enable on-site printing of reports.
• First-class mail
• Facsimile: Please specify “Fax Results” in writing on
the test requisition.
Scheduled Tests
The following tests must be scheduled:
• Sweat chloride
• Osmotic fragility
• Semen analysis
Please call Rockford Health Laboratories at 815-971-LABS
(5227) to schedule an appointment.
• Patient name
• Unique identifier such as medical record number
• Date of birth
• Date and time of collection and collector’s initials
• Culture specimens, please indicate source and site (ie,
source-wound, site-left arm)
Specimen Rejection
Our goal is to ensure that all specimens submitted to the
laboratory are of the highest quality and are collected, labeled,
and transported in the proper manner. Upon receipt, each
specimen is carefully inspected for specimen acceptability. The
laboratory reserves the right to reject specimens, which may
affect the quality of results. Reasons for specimen rejection,
include the following:
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Unlabeled or improperly labeled specimen container
Grossly hemolyzed specimen
Specimens collected in the incorrect tube or container
Specimens not accompanied by the proper completed
test request form
• Specimens not collected with proper patient preparation
• Specimens not delivered to the laboratory within the
required time frame or at proper temperature
If a mislabeled or unlabeled specimen is one that cannot be
recollected (ie, spinal fluid, biopsy specimen), the laboratory
will allow re-labeling by the person who collected the
specimen. In all other cases, the ordering physician office will
be notified of the specimen problem or rejection. This may
result in reporting delays.
Specimen Transport
To assure the highest quality of laboratory testing, all specimens
should be delivered promptly to the laboratory after collection.
Please refer to specific transport information for individual
tests, including allowable transport time, proper containers, and
temperature. A convenient courier schedule will be supplied to
all clients.
In order to follow all federal and health system guidelines
regarding patient and worker safety, all specimens must be
transported in a proper manner. Specimens must be transported
in a tightly sealed container with no external contamination or
spillage within a closed biohazard bag. Centrifuged specimens
need to remain upright at all times. The test requisition should
be placed in the pocket of biohazard bag.
Standing Orders
RHML will accept standing orders, and they will be tracked
electronically. Required information includes:
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Date order is written
Patient’s complete name
Patient’s date of birth
Patient’s medical record number, if applicable
Physician’s name
Physicians signature
Test(s)
Frequency of testing
Test-specific ICD 9 codes
Any special instructions or other pertinent information
Stop date if less than one year
All standing orders are only valid for one year from the date
order is written.
Test Requisition
Many RHML clients are able to submit orders to the laboratory
and patient service centers via online software. Please consult
the connectivity solution manual or call our Customer Service
Department for assistance.
For clients who do not utilize online connectivity, printed
requisition forms are available for routine clinical, histological,
and cytological testing. Printed requisition forms are available
by calling our Customer Service Department at 815-971-LABS
(5227).
Using these forms ensures timely and accurate processing of
your order, specimens, and results. Orders not sent with the
patient may be forwarded to an outpatient service center by mail
or facsimile (see “Locations and Hours of Operation” [p. 4] for
a listing of addresses and fax numbers).
Please include the following information on all test requisitions:
• Date specimens are to be collected (include time if
applicable)
• For collected specimens:
— Date and time of collection and source of specimen
— Patient’s complete name
— Patient’s gender
— Patient’s date of birth
— Patient’s complete mailing address
— Responsible party’s/insured’s name and address if
other than patient
— Ordering physician’s name, address, and signature
— Ordering physician’s NPI number
— List all applicable ICD-9 diagnosis codes to their
highest level of specificity for each test ordered
— Complete name of the insurance company and
address
— Medicare, Medicaid, or insurance/managed care
(HMO) insured ID member number as it appears
on the insurance card
— Group/policy number as it appears on the insurance
card (a copy of both sides of the insurance card
may be provided)
Test Turnaround Time
Turnaround time is critical to patient care and is an important
component to our quality assurance program. Turnaround time
is the interval between specimen receipt in the laboratory and
results reporting.
STAT Testing
• Whole blood: <30 minutes
• Plasma: <45 minutes
• Serum: <60 minutes
• Gram Stain: <60 minutes
• Rapid infectious antigen tests: <60 minutes
Verbal Orders
Verbal or telephone orders are allowed in situations in which
the patient requires immediate treatment. We require that all
verbal/telephone orders be given to our Customer Service
Representatives at 815-971-LABS (5227). All verbal and
telephone orders will be read back to the caller for verification
and accuracy. These orders are followed up with a letter to the
ordering physician requesting written authorization within 30
days of the oral request.
Please phone all verbal orders to our Customer Service
Representatives at 815-971-LABS (5227).