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Education & Training

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, 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, 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)

Advanced Technology Laboratory, Cytology, Education & Training, Referral/Sendouts

New Test: HPV High Risk Screen with HPV Genotype Reflex

Effective August 26, 2024,  Corewell Health Laboratories West will be updating their High-Risk HPV testing.  The new assay will be performed on the Abbott Alinity m at Corewell Health Reference Laboratory West, Grand Rapids.  Testing will now automatically include HPV Genotype results whenever HPV is detected.  There will no longer be a separate charge to the patient for HPV Genotype testing.

There will also be an expanded number of High-Risk HPV Genotypes reported:

  • HPV Genotype 16
  • HPV Genotype 18
  • HPV Genotype 45
  • HPV Genotype 31/33/52/58
  • HPV Genotype 35/39/51/56/59/66/68

The new assay is FDA approved for Primary screening in addition to co-testing.

Post hysterectomy vaginal specimens will still be a send out test (LAB1230722). Continue Reading

Education & Training, General Information, Test Utilization

Thyroid Disease Awareness Month

Written by Yasel Fleitas Alvarez, Ph.D., Chemistry Clinical Advisor, Corewell Health Reference Laboratory West, Michigan Pathology Specialists.

This January we are celebrating the National Thyroid Awareness Month. In United States of America, it is estimated that approximately 20 million people have thyroid disease and most importantly, according to the American Thyroid Association (ATA) as many as 60% of people suffering from a thyroid disorder are not aware they have it.The thyroid is a butterfly shaped-gland located at the front of the neck that produces and release thyroid hormones (See Figure 1).

Figure 1. Thyroid Gland Anatomy and Histology

 

It regulates important physiological functions as:

    • Breathing
    • Heart rate
    • Energy production
    • Muscle strength
    • Body temperature
    • Weight
    • Mood

Thyroid disease can present in two main forms:

  1. Hypothyroidism (under functioning thyroid)
  2. Hyperthyroidism (over functioning thyroid)

Confirmation or exclusion of thyroid disease requires a clinical examination combined with biochemical determination of thyroid hormones (TH) and thyrotropin (TSH)concentrations.

In this blog we discuss the best practices for ordering thyroid function tests for the initial screening of thyroid disease at Corewell Health.
Continue Reading

Education & Training, General Information

Lab Specimen Label Printing Update for Corewell Health Epic Users

On 10/31/23, a change was made to lab specimen labels, which included a patient’s preferred name on the label, if it is documented in Epic. This highlighted a change in the names of label types seen by staff when reprinting specimen labels in Epic. Due to a mix of Intermec and Zebra printers across the entire Corewell Health system, defaults needed to be removed from Epic build to account for these differences. Users will now be required to manually choose the correct label type when reprinting labels. The Collection Activity behavior should remain the same. Continue Reading

Education & Training, General Information, Immunochemistry, Test Utilization

Webinar: Optimizing Care of the Respiratory Patient – The Role of Specific IgE Testing

It’s the season of sunshine and blooms which also means it can be a season of sneezing, itching, and a lot of trouble getting a good breath in for some.

⇒Are you prepared to meet the needs of your patients that may be suffering from some of these symptoms?
⇒Are you well versed in the difference between a sensitivity and a clinical allergy and how you can differentiate between the two?
⇒Do you know the resources we have at Corewell Health to assist in these determinations? Continue Reading

Education & Training, General Information, Histology

Best Practices for Small Tissue Material

Tissue specimens less than 0.1cm may yield insufficient results if submitted for Tissue Pathology. To make the best use of diagnostic tissue material please follow the below guidelines:

Biopsy Size Order Code Test Preservative
<0.1cm LAB2111263 Fine Needle Aspiration (FNA) Cytology *CytoLyt solution
>0.1cm LAB8 Tissue Pathology 10% Formalin

*Place entire specimen in CytoLyt. Do not attempt to make smears from specimen.

Please contact the Corewell Health Pathology Department at (616)267-2622 Mon-Fri, 8am-5pm, or the Corewell Health Laboratory Call Center at (616)774-7721, 24/7 to speak with a Pathologist.