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Compliance & Safety

Compliance & Safety, Education & Training, General Information

Updated Advanced Beneficiary (ABN) Statuses (Corewell Health Epic Users)

On Tuesday, Jan. 7, you will see changes to the ABN Status list in Epic, making it easier to select the appropriate status from available options.

In an effort to optimize workflows, the ABN statuses in Epic have been changed to be more efficient. Some statuses have been removed based on volume of use and feedback from clinicians. Other options have been changed to ensure clarity after review by Informatics, Compliance, and Revenue Cycle. The information below lists the new options and when to use them. Please refer to Epic Proportions for more information.

Attention providers: to reduce your ABN workflow burden, please select one of the first two Provider ABN statuses at the time of order entry only. The collection of signed ABN waivers will occur later by office, laboratory, or imaging staff using the three ABN Signed statuses when the specimen is being collected or when the imaging procedure is being performed. If your office routinely collects laboratory specimens, please instruct your staff to collect ABN signature waiver at the time of specimen collection.

Status Options Available after January 7, 2025:

  • Provider: ABN Discussed. Await Signature. [205] = Providers placing orders when the patient is present to discuss ABN, select this option. This allows the provider to place the order while also allowing lab or radiology staff the ability to complete their process as usual later and avoid the need for a new order. Patient will sign during lab/imaging procedure.
  • Provider: ABN Not Discussed. Patient Not Present. [206] = Providers placing orders when the patient is not available or present, select this option. This allows the provider to place the order while also allowing lab or radiology staff the ability to complete their process as usual later and avoid the need for a new order. Lab/imaging will need to discuss ABN and sign.
  • ABN Signed, Service Accepted (Option 1 – Bill Medicare) [3] = This status indicates that a patient has signed the form, wants to receive the service, and agrees to be financially responsible for the service if Medicare does not pay. This option should only be used by the person who is presenting the ABN to the patient for signature.
  • ABN Signed, Service Accepted (Option 2 – Do not Bill Medicare) [9] = This status indicates that a patient has signed the form, wants to receive the service, agrees to be financially responsible for the service, and agrees not to bill Medicare. This option should only be used by the person who is presenting the ABN to the patient for signature.
  • ABN Signed, Service Declined [6] = This status indicates that a patient has signed the form and does not want to receive the service. Typically, the clinician cancels the order in this situation. If a patient signs the form and declines the service but the physician believes it is important to proceed with the service at Corewell Health’ expense the test should not be canceled.
  • Notice Printed [2] = This status is automatically assigned to an ABN when the ABN is printed. In practice, “ABN Printed” can function as either an initial or intermediate status, because staff can print a copy of the ABN before or after presenting the form to the patient.
  • Notice Triggered [1] = This status is automatically assigned to new ABN forms. Indicates an ABN warning has been prompted. The order/procedure will NOT be able to be signed when the ABN is in this state.
Compliance & Safety, Hemostasis/Coagulation

Update: Platelet Aggregation Studies Scheduling

Effective immediately, platelet aggregation testing will require a pathology consult prior to scheduling for testing performed at Corewell Health Reference Laboratory West, Grand Rapids. This consult request must be completed prior to scheduling the patient for testing.

After consultation the testing may be ordered and scheduled.

As a reminder testing is performed for scheduled patients Monday – Thursday from 7:30 am-9:30 am at the 35 Michigan Street Laboratory. Patients should be resting, fasting, non-smoking, and should not be pregnant. Patients should avoid taking any prescription or over the counter medications known to affect platelet function for ten (10) days to two (2) weeks prior to the test. Click for a list of medications with known anti-platelet effects.

Test Information:

 

Compliance & Safety, Education & Training, General Information

Reminder: Thin Prep Collection

With the August changes to STI testing Corewell Health Reference Laboratory West has seen an influx of incorrect orders. As a reminder, not all STI testing can be performed off of a Thin Prep® specimen. The STI Panel includes four different tests: Gonorrhea PCR, Chlamydia PCR, Trichomonas PCR and Mycoplasma Geniltalium PCR (Mgen). Unlike the other testing, Mgen cannot be added on to the Thin Prep® container.

 

If an STI Panel is ordered and the only specimen that is collected is a Thin Prep®, laboratory staff will independently cancel the STI panel and reorder the three tests that are able to be completed off of the specimen that is submitted. If an Mgen test is still needed, please submit a separate urine or swabbed collection using the Alinity -M collection kit.

Compliance & Safety, General Information, Test Utilization

Lipid & Vitamin D policy for Medicare patients

Traditional Medicare insured patients who have a Lipid Panel or Vitamin D 25 ordered more than once per 12 months are not covered due to medical necessity.*

If testing is indicated, you will need to provide an appropriately executed Advance Beneficiary Notice (ABN) for Corewell Health Southeast Laboratories and Advance Beneficiary Notice for Corewell Health Southwest and West Laboratories signed by the patient indicating they would like testing and understand they may be financially responsible for payment (ABN: Option 1). ABN must be submitted with specimen.

For testing ordered inside this frequency range without an ABN, Corewell Health will implement an automatic cancellation. Continue Reading

Compliance & Safety, Education & Training, General Information

IMPORTANT: Lipid Testing Changes

Effective Monday, September 16, 2024 all Corewell Health ambulatory offices will see an increase in Frequency Advance Beneficiary Notices (ABN) when ordering Lipids. This ensures compliance with Medicare requirements. ABNs serve as an indication to ordering physicians and APPs that the order has a stipulation for coverage and that Medicare may not reimburse for services; the patient will need to acknowledge potential financial responsibility. Having this completed ABN on file allows Corewell Health to provide and bill for services.

Specific to lipid frequency ABNs:

• Screening: Medicare covers testing once every 5 years. Per CMS, lipid testing in asymptomatic individuals is considered screening regardless of the presence of other risk factors such as family history, tobacco use, etc.
• Monitoring: Medicare covers testing once annually for monitoring the lifestyle and/or pharmaceutical treatment of lipid disorders. If more frequent testing is medically necessary after initiation of therapy, Medicare will cover up to six total cholesterol or LDL labs in the first year of therapy.

Lab will collect any ABNs needed if not collected prior to patient collection at our Patient Service Centers. If collection occurs in the office, be sure to follow the process: Ambulatory Clinical – Completing the Advance Beneficiary Notice (ABN) from the Epic Education Team SharePoint page. Any Medicare patient specimen submitted for lipid panel testing without an ABN will NOT be tested by the laboratory.

For more information on the CMS requirements for lipid testing, please review the NCD – Lipid Testing (190.23) (cms.gov)

Chemistry, Compliance & Safety

Parathyroid Hormone Corrections

An equipment issue resulted in artificially high parathyroid hormone results for some patients from July 31- August 17, 2024. We have repeated testing on the potentially affected samples, corrections were made as necessary, and providers for the impacted patients have been notified.

Review of quality indicator data suggested that issue affecting the results began July 31. Not all patient values were affected, but those that were had artificially high values. The laboratory repeated all PTH testing from this instrument for which remaining sample was available, corrected results, and contacted providers via epic inbox message for CHW providers and other appropriate means for CHW affiliates and external providers whose lab work is performed at CHW in Grand Rapids. Providers of potentially impacted patients whose samples could not be repeated have also been notified.

Recommendations Continue Reading

Compliance & Safety, General Information

Lab Specimen Drop Off Policy Change

Effective Tuesday, February 20, 2024, the policy for home collected specimen drop offs for Outpatient Laboratories (“draw sites”) has been updated.

For all Corewell Health West Michigan locations: after registration, patients or their designated person will verify the specimen at the laboratory. Laboratory team members will verify the specimen is properly labeled and ensure they have everything needed to be able to test the specimen before the patient or their designated person leaves the building. This does not include specimens collected by a home health nurse or provider.

This will standardize our patient flow when arriving with a home collected specimen and will reduce the need for recollection due to missing information or improper collection.

When specimen collection orders are placed, please notify patients of the change to this process.

RELATED RESOURCES

Lab Specimen Home Collection Guide

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Compliance & Safety, Referral/Sendouts, Test Utilization

Reminder: Send Out Referral Testing Notice

As a reminder, referral testing, tests that are sent to another laboratory to perform, is dependent on the weather. Inclement weather can affect both the turnaround time of testing, and the testing capabilities of the organization. Our referral testing is dependent on outside transportation facilities (such as FedEx and UPS). When those organizations face challenges in weather, our testing capabilities must remain flexible. 

If there is inclement weather in and around Memphis, TN (the main FedEx hub), there may be delays and cancellations of testing. We will try our best to communicate these changes as soon as possible via our blog: https://lab.corewellhealth.org/

For any questions or concerns please “Contact Us” via the link above. 

Advanced Technology Laboratory, Compliance & Safety, General Information

Genetic Testing Informed Consent

Submission of an order for any predictive genetic tests and pre-symptomatic genetic tests, as defined by MCL 333.17020, contained in Corewell Health laboratory catalog constitutes certification to Corewell Health Laboratories that the ordering physician understands that written, informed consent is required for these tests and that, by submitting an order for these genetic tests, ordering physician has obtained “Informed Consent” of subject patient as required by any applicable state or federal laws with respect to each test ordered. On occasion, we forward a specimen to an outside reference laboratory. Corewell Health laboratories may request that ordering physician provide such consent to Corewell Health upon a reasonable request.

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Compliance & Safety, Education & Training, General Information, Main lab, Test Utilization

Inform: RSV Testing – Age Restrictions

Respiratory syncytial virus (RSV) primarily infects pediatric patients, but occasionally infects adults and may be of particular concern for the elderly and immunocompromised. Corewell Health Laboratories offers two tests for RSV. A rapid antigen test may be used to confirm RSV diagnosis in pediatric patients. This test is not approved by the FDA for testing adult patients, so tests will be cancelled if ordered on an off-label age group. There are no age restrictions for RSV testing by way of a molecular panel that also includes COVID and influenza as viruses with overlapping symptoms.

Test name Epic Test ID Methodology Specimen Age restriction
RSV Rapid LAB495 Antigen Nasopharyngeal (NP) swab Approved for patients 0 – 18 years of age
COVID, Influenza, RSV PCR LAB1230746 Molecular/PCR Nasopharyngeal (NP) swab No age restriction