Laboratory orders may be transmitted from patient care units to the Laboratory Information System (LIS) by computerized order-entry on the Hospital Information System (HIS). Once these orders are received by the LIS, the system will consolidate orders, edit for duplicates and schedule them so that labels will print at an appropriate time. Labels will print on a barcode printer on the patient units, so that samples can be positively identified at the bedside by clinical staff. These barcode labels facilitate rapid processing of the sample in the laboratory.
In an effort to assure that all requests are created by authorized providers, forms will be provided by CMMC to physicians and other providers that routinely submit test requests (the process for qualifying an individual to order laboratory procedures is identified in the section “Test Authorization”). Requisitions that are created on other information systems within Central Maine Healthcare are subject to review by the laboratory.
Requisition forms will be formatted to promote the conscious ordering of tests by physicians or other authorized providers (i.e, all components of panels will be indicated clearly on the requisition and will also have the items listed individually so as to promote discreet ordering). The forms will also be designed to capture appropriate diagnostic and clinical information which will serve as documentation to support the medical necessity of the service the laboratory will provide and bill to a federal or private health care program.
Requests for patient laboratory testing may originate from a number of different health care providers, both within the State of Maine and other states. It is important that these providers be legally authorized to order such testing and that they be sufficiently knowledgeable about the requested test(s) to properly interpret the test results and implement appropriate medical follow-up.
The following health care practitioners shall be permitted to submit requests for laboratory testing on their patients to the laboratory at Central Maine Medical Center:
- Medical Doctors (MD) or Doctors of Osteopathic Medicine (DO) holding a valid and currently active medical license in the State of Maine.
- Medical Doctors (MD) or Doctors of Osteopathic Medicine (DO) holding a currently valid, active and unrestricted medical license in their primary State of practice.
- Nurse Practitioners holding a currently valid, active and unrestricted license of their specialty in the State of Maine.
- Certified Nurse Midwives holding a currently valid, active and unrestricted license of their specialty in the State of Maine.
- Physician’s Assistants holding a currently valid, active and unrestricted license of their specialty in the State of Maine.
All other practitioners permitted by Maine State Law to order laboratory testing.
The Laboratory requires a physician/provider's signature (or a provider/physician’s name co-signed by an authorized representative) on all orders that are processed. Any orders received without a signature, i.e. phoned orders, will be followed up to request a signature from the provider. This process will include second requests for those signatures that are not returned in a timely fashion. These signature documents will be retained and archived.
For orders which are received without adequate diagnosis/clinical information, requests will be made to the provider’s office to obtain more complete information. This process will involve ordering a diagnosis request (DX REQ) procedure on the laboratory information system, which will generate a letter to the provider requesting additional diagnostic information. This information will be faxed back to the coding department who will update the patient registration and will archive the data electronically.
At times patients may be undergoing extended courses of treatment which necessitate repetitive laboratory orders (i.e., patient on coumadin therapy requiring monitoring of INR levels). In these situations, a provider may submit an order indicating the diagnosis as well as testing frequency. These orders can be in effect for up to six months, at which time the laboratory will request a renewal of the original order.
Advance Beneficiary Notices
ABNs are used when there is a likelihood that an ordered service will not be paid by a patient’s insurance. Before the service is furnished, the beneficiary should be notified, in writing, of the likelihood that the specific service will be denied. After being so informed, the beneficiary has the choice to either: (1) decide to receive the service and agree to pay by signing the ABN or (2) decide not to receive the service and therefore not sign the ABN. Beneficiaries should not be asked to sign blank ABNs.
The notice must be in writing, must clearly identify a particular service, must state that payment for the particular service likely will be denied and must give the reason for the belief that payment is likely to be denied. It is the laboratory’s responsibility to produce the ABN at the request of an authorized individual.
Notices should not be given to beneficiaries unless there is some genuine doubt that charges will be covered.
Information Resources and Free Care
- In cases when a provider’s order is believed to be inadequate with respect to supporting diagnostic information AND there is a belief that this lack of information could be corrected through a simple follow-up to the provider or provider representative, the ABN should not be obtained. Letters will be sent in these cases to obtain the needed information.
- In cases when a provider indicates “Screening” and there is a clear indication that charges will not be covered, an ABN should be obtained. ABN brochures should be provided to patients to explain the policies surrounding the ABN.
Patients who are concerned about the specific details of the ABN, their benefits, and/or Free Care should be encouraged to contact Patient Financial Services for assistance. They may be reached at 795-2237 or from the following link: http://www.cmmc.org/pf-freecare.html