2014 Notice to Physicians

Transcription

1 2014 Notice to Physicians August 20, 2014 Dear Physician, will only pay for tests that are deemed medically necessary. These regulations impact physicians who order the tests as well as the laboratories that perform them. To prevent fraud and abuse in laboratory testing, we ask that you comply with the following: may not pay for tests covered by a National Coverage Decision (NCD). If a test with a non-covered diagnosis by NCD is ordered, the patient will be asked to sign an Advance Beneficiary Notice before sample collection, which notifies the patient that they will be billed by the hospital if denies coverage and gives the patient the choice of not having the testing performed. Organ or disease related panels will only be paid and will only be billed when all components are medically necessary. Using a customized profile may result in ordering of tests that are not covered, reasonable or necessary. Attached is a list of our panels that includes the reimbursement paid for the panel or each component of a customized panel. The fee schedule is available on-line or in the laboratory. The Medicaid reimbursement amount will be equal to or less than the amount of reimbursement. Dahl-Chase Pathology Associates (DCPA) provides clinical consultation for the Penobscot Valley Hospital Laboratory. A pathologist is always available for consultation at or off hours. Dr. George Eyerer from DCPA is the laboratory Medical Director. The Office of the Inspector General takes the position that an individual who knowingly causes a false claim to be submitted may be subject to sanctions or remedies available under civil, criminal, and administrative law. Please take a few moments to review the attached information. If you have any questions about the information please contact the laboratory at ext 244. Scott Warner, MLT (ASCP) Director of Laboratory Services

2 2014 Laboratory Test s Test Name Basic Metabolic Comprehensive Metabolic Connective Tissue Individual Components with CPT Codes Sodium (84295) Sodium (82495) Alk Phos (84075) Rheumatoid Factor (86431) C-reactive protein (86140) Antinuclear antibodies (86038) Electrolyte Sodium (82495) Hepatic Function Iron, Total Iron Binding Capacity, % Saturation (calculated) Alk Phos (84075) Bilirubin Direct (82248) Iron (83540) Iron Binding Capacity (83550) CPT Code(s) billed to $ $ Current Reimbursement $7.98 $ $ $ $9.12 $12.30

3 Preeclampsia Uric Acid (84550) Renal Sodium (84295) Phosphorus (84100) $4.08 $5.56 $7.22 $7.44 $7.06 $5.16 $ $12.22

4 2014 Laboratory Reflexive Testing Test Name Individual Components with CPT Codes Lipid Cholesterol, Total (82465) Cholesterol, HDL (83718) Triglyceride (88478) Calculated LDL Direct LDL (83721) Is done if Triglyceride is greater than 400 mg/dl CPT Code(s) billed to $ $12.91 Current Reimbursement Thyroid TSH (84443) $23.64 Free T4 (84439) $12.69 Is done if TSH is abnormal CBC w/ Diff WBC (85048) RBC (85041) Hemoglobin (85018) Hematocrit (85014) Platelet (85595) RBC indices, calculated Five part differential $10.94 Urinalysis Routine A manual differential (85007) is performed if automated differential parameters are suspect per criteria or absent. These A blood smear scan without differential (85008) is performed if above parameters are suspect per criteria. Automated without microscopy (81003) Microscopic (81015) Examination is done if dipstick results exceed defined limits. These $9.11 $ $ $ $4.45 Urinalysis Reflex Automated without $3.16 microscopy (81003) Microscopic (81015) $4.45

5 Examination is done if dipstick results exceed defined limits. These Rapid Strep Screen Connective Tissue Disease Urine culture, including a colony count (87086) and isolation and identification (87088), is done if dipstick and/or microscopic results exceed defined limits. These criteria are available in the Streptococcus screen (87880) Culture, bacterial (87081) Screen only, single organism is done if rapid screen is negative on patients less than 18 years C-Reactive Protein (86140) Rheumatoid Factor (86431) ANA (86038) If ANA is 1:160 or greater, Anti-dsDNA (86225) Complement 3 (86160) Complement 4 (86160) $11.36 $ $ $ $7.98 $17.01 $19.33 $15.69 $15.69