About Our Laboratory
The Doctors Hospital Laboratory is a full-service Laboratory open 24 hours per day, 365 days a year. We operate and comply with applicable federal and state laws and regulations under the Georgia Department of Human Resources and the Clinical Laboratory Improvement Act of 1988. The Laboratory, Blood Bank and Pathology Departments maintain accreditation with the College of American Pathologists (CAP), and the Joint Commission on Accreditation for Hospital Organizations (JCAHO).
We are licensed by the State of Georgia to perform the following testing: Syphilis Serology, Non-Syphilis Serology, Viral Serology, HIV screen, Routine Chemistry, Urinalysis, Blood Gases, Medical Toxicology, TDM, Hematology, Immunology (including Group, Type, Crossmatch, Antibody Screen & Identification, & Transfusion Services storage), Bacteriology II, Mycology I, Parasitology, Mycobacteriology II, Anatomic Pathology, Oral Pathology, and Exfoliative Cytology.
Availability of Laboratory Testing Information
It is the policy of Doctors Hospital Laboratory to make available to our clients a list of current test methods, performance specifications, specimen requirements, CPT/HCPC codes, pricing structure and other information (testing sites). Please let us know if there is any information you require regarding testing methodology or performance.
Delayed Reporting of Patient Results
It is the policy of Doctors Hospital to report all patient results within established turn-around-times. When circumstances occur in which reporting of patient results will be delayed, the Laboratory and the Medical Staff have established when notification to the physician is important for patient care. All STAT results are called to the physician, but if problems arise which prevent timely result notification (2 times the STAT turn-around-time listed in the Department Policy and Procedure Manual), then the physician will be informed regarding the expected time of report.
For Routine results, notification will be made when the expected turn-around-time exceeds 24 hours. Notification will be made in the most efficacious manner possible, such as by telephone, email or by fax.
Physicians are advised by CMS to only order those tests which are medically necessary. If a test is not medically necessary, an Advanced Beneficiary Notice (ABN) must be obtained from the patient. Please understand that the guiding principle to determine whether an ABN should be obtained is not whether you, as a physician believe that, the test is medically necessary, but whether the patient’s diagnosis, sign, or symptom are listed within the NCD as diagnoses which are covered by Medicare. In each NCD, there are three ICD-9 CM code listings. There are ICD-9-CM codes which are covered by Medicare, there are ICD-9-CM Codes, which are never covered by Medicare (do not require an ABN, patient automatically billed) and ICD-9-CM codes which usually do not support medical necessity (ABN required). Please continue to provide us with diagnosis codes and/or descriptions for any Laboratory order and please remember to provide written authorization for that order. We can continue to accept verbal orders for Laboratory tests, but we are required by HCA to obtain written authorization for those orders. Because, we understand how confusing medical necessity language can be for your patients, we have brochures available which may help in answering their questions. The questions, which are contained in those brochures, are provided to you, within this manual. If you would like to use these brochures in your office, please contact the laboratory, and if you would like any or all of the NCD policies, please contact the laboratory and we will provide them to you.
Laboratory Billing Compliance
The Laboratory at Doctors Hospital follows the HCA Laboratory Billing Compliance Plan, which incorporates the components of the Office of the Inspector General (OIG) Laboratory Compliance Plan. The Plan was developed to reinforce a culture of honesty, integrity, and fairness in the way in which we provide laboratory services and is designed to cover laws and regulations related to ordering, testing, and billing of laboratory services. This directory is one component of the plan and was organized in a manner which would provide you with a complete listing of tests, test requirements, CPT codes, and prices. Updates to this directory, which are brought about from technical advances or CMS (Centers for Medicare and Medicaid Services) revisions, will be provided to you in a timely manner. In 2003, National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) became fully operational. A NCD for a diagnostic laboratory test is a national policy statement issued by the Department of Health & Human Services and CMS. The NCD defines the circumstances under which the test will be considered reasonable and medically necessary and further defines the limitations and exclusions of medical coverage for that test or group of tests. These policy statements apply nationwide and are binding on all Medicare carriers, fiscal intermediaries (FI), peer group organizations, health maintenance organizations, competitive medical plans, and health care prepayment plans. There are 23 clinical laboratory NCDs and they are designated within this pricing guide with bold type and within a table under the heading Medical Necessity. LCDs are defined by the fiscal intermediaries (FI) or Medicare carriers and may further restrict the coverage of tests that have NCDs or may define additional tests whereby coverage will be limited by medical necessity or frequency.
Questions you may be asked about Medicare Coverage of Laboratory Tests
An ABN is a form that lets you know that you may have to pay for a test your doctor has ordered if Medicare refuses to pay for it. Once you sign an ABN, the lab may bill you for the cost of test.
Although the Medicare program pays for most lab tests, it will not pay for some tests under some circumstances. When that happens, our Lab must ask the patient to pay. Consequently, we ask the patients to sign an ABN whenever Medicare appears to deny payment for a specific test the doctor has ordered. The reason you are being asked to sign an ABN now is that this is one of those occasions in which we or your doctor believe Medicare will not pay.
No, you have 3 options: Option 1: You may sign the ABN and have the test performed. You can then be billed for the test.
Option 2: You may refuse to sign the ABN and choose not to have the test done. However, in not having the test done, you will be going against the medical advice of your doctor. So we advise you to consult with your doctor before choosing this option.
Option 3: You may refuse to sign the ABN and go ahead with the testing. Our lab will perform the test and you will receive a bill - even though you refused to sign the ABN. A witness will sign the ABN to indicate that you have been advised of the ABN, refused to sign it, but still want the test performed. Under Medicare guidelines, we are required to then bill you directly for the tests.
Medicare pays only for tests that it considers medically necessary. Some tests are always considered medically necessary; but most tests fall in the middle, they are medically necessary only under certain circumstances, depending on the patient’s diagnosis. If the diagnosis the doctor lists is not one of the diagnoses Medicare will accept for that test (or if the doctor does not tell the lab what the diagnosis is), the test will not be considered medically necessary and Medicare will not pay for it.
Your doctor has made a medical judgment that you need the test. When your doctor says a test is medically necessary, he/she considers your personnel medical history, any medications you may be taking, and generally accepted medical practices. When Medicare says a test is not medically necessary, it is not making a medical decision about your health. It is acting like an insurance company deciding what it will and will not pay for. And, just like private insurers, there are occasions when Medicare will not pay for services doctors think are important to a patient’s health. But as the ABN says, you have the option not to have the test done. If you have questions about a specific test your doctor has ordered for you and why it is medically necessary, please consult with your physician.
No, after the lab performs the test, we will ask Medicare to pay for it. If Medicare does pay for it, you will not receive a bill. You will get a bill only if Medicare denies the claim. Remember that if Medicare denies the claim, you may contest the denial if you think it was wrong. Contact your doctor or Medicare if you want to do that.
Neither. The fact that you have signed an ABN will not affect Medicare’s decision either way.
Maybe. If you have a supplemental insurance policy (sometimes called a “Medigap” policy), contact the insurance company and ask whether the policy covers lab tests not covered by Medicare. If so, find out how to submit claims for payment under the policy.
No. You will be asked to sign an ABN only when the doctor or lab has good reason to think that Medicare will deny payment for the ordered test. So there may be visits to the doctor’s office or lab when you will be asked to sign an ABN and other visits when you will not. It all depends on the test and the reason for ordering it on that visit.
There was no reason to believe Medicare would deny payment for the tests the doctor ordered for you during previous visits. But your doctor or we think that Medicare will not pay for the test being ordered today. Although you should ask your doctor what the difference is between today and other visits when you did not have to sign and ABN, here are some likely possibilities:
- Your doctor ordered different tests on previous visits
- This is the first time he/she is ordering this particular test
- This is the same test your doctor ordered but your diagnosis has changed - that is, the doctor is ordering the test for a different reason
- This is the same test and the same diagnosis, but since your last test, Medicare changed the rules and no longer pays for the test under this diagnosis.
Main Laboratory: (706) 651-6545
Fax for Physician Orders: (706) 651-6568
|Pathologist/Medical Director, Stephen D. Adams, D.O.||(706) 651-6544|
|Pathologist, Deborah Richardson, M.D.||(706) 651-6544|
|Director of Diagnostic Services, John Doriot||(706) 651-6571|
|Laboratory Courier, Gina Vera||(706) 651-6565, Cell: (706) 830-4202|
|Billing Concerns ; Laboratory Pricing, John Doriot||(706) 651-6571|
|Blood Bank, Barbara Muns, Supervisor||(706) 651-6570|
|Chemistry & Hematology, Kim Tucker, Lab Mgr||(706) 651-6553|
|Clerical, Registration & Verbal Orders||(706) 651-6545|
|Computer (Meditech), Karen Fisher||(706) 651-6587|
|Histology, Wynelle Taylor, Supervisor||(706) 651-6572|
|Immunology, Dianne Giddens, Supervisor||(706) 651-6573|
|Microbiology, Ed Singletary, Supervisor||(706) 651-6584|
|Pathology Secretary, Vickie Jones||(706) 651-6544|
|Phlebotomy Services & POC, Vicki Jordan, Supervisor||(706) 651-6569|