Transcription
  • Is the patient Medicare. Any other Payor. Yes.
  • Patient Status Whn Sample Originally Collected (Patient has to be discharged). Inpatient. Hospital Outpatient.
  • Date Ordered by Provider after Discharge. 14-30 days. Less than 14 days of discharge. > 30 days .
  • Date of Service becomes:. Original Collection Date.
  • Who is required/allowed to bill for the testing? Hospital REQUIRED to bill Medicare.
  • Is the Reference Lab willing to bill patient directly? Hospital REQUIRED to bill patient. Ref Lab must bill SHMC.
  • Proceed to next steps? Proceed.
  • Decision Point: Responsible Billing Party (Hospital or Patient). Bill Hospital/Client (SHMC).
  • *Order in Cerner *RedCap Misc Sendouts *Use original EPIC Registration.
  • Date of Service becomes:. Date the Test is Performed.
  • Who is Required or Allowed to Bill for the Testing? Reference Lab Allowed to Bill the Patient's Insurance.
  • Is the Reference Lab Willing to Bill Patient Insurance Directly? Yes, but req is marked bill SHMC. No. Yes.
  • Steps:. Move onto Next Steps.
  • Decision Point Responsible Billing Party (Hospital or Patient). Bill Patient Insurance.
  • *RedCap Pass Through Sendouts.
  • Steps:. *Send test out, mark req. "Bill SHMC/Client" *Send paperwork for UM tracking.
  • Decision Point Responsible Billing Party (Hospital or Patient). Bill Hospital/Client (SHMC).
  • *Order in Cerner *RedCap Misc Sendouts *Follow DOS Rules.
  • Steps:. *Send test out, mark req. "Bill SHMC/Client" *Send paperwork for UM tracking.
  • Decision Point Responsible Billing Party (Hospital or Patient). Bill Hospital/Client (SHMC).
  • *Order in Cerner *RedCap Misc Sendouts *Follow DOS Rules.
  • Date of Service Becomes? Date pulled from Archive.
  • Who is Required or Allowed to Bill for the Testing? Reference Lab Allowed to Bill the Patient's Insurance.
  • Reference Lab Allowed to Bill the Patient's Insurance? Yes. Yes, but req is marked bill SHMC. No.
  • Steps:. Move onto Next Steps.
  • Decision Point Responsible Billing Party (Hospital or Patient). Bill Patient Insurance.
  • *RedCap Pass Through Sendouts.
  • Steps:. *Send test out, mark req. "Bill SHMC/Client" *Send paperwork for UM tracking.
  • Decision Point Responsible Billing Party (Hospital or Patient). Bill Hospital/Client (SHMC).
  • * Order in Cerner *RedCap Misc Sendouts Tracking *Follow DOS Rule Chart.
  • Steps:. *Send test out, mark req. "Bill SHMC/Client" *Send paperwork for UM tracking.
  • Decision Point Responsible Billing Party (Hospital or Patient). Bill Hospital/Client (SHMC).
  • * Order in Cerner *RedCap Misc Sendouts Tracking *Follow DOS Rule Chart.
  • Date Provider Ordered Test (Actual Date on Order). Any date after hospital discharge.
  • Date of Service becomes:. Date the test is performed.
  • Who is required/allowed to bill for the testing? Reference Lab REQUIRED to bill the patient's insurance.
  • Is the Reference Lab willing to bill patient directly? Yes. No.
  • Proceed to next Steps? Proceed.
  • Decision Point Responsible Billing Party (Hospital or Patient). Bill patient insurance.
  • *RedCap Pass Through Sendouts.
  • Hard Stop. * Order Misc. test in Cerner with Order Note "Ref. Lab refuses to Bill" * Send paperwork for UM tracking.
  • Decision Point Responsible Billing Party (Hospital or Patient). Bill Hospital/Client (SHMC).
  • * Order in Cerner *RedCap Misc Sendouts Tracking *Follow DOS Rule Chart.
  • Patient Status. Inpatient, Hospital Outpatient, OP Non-patient, Specimen.
  • Date Provider Ordered Test (Actual Date on Order). Any date after discharge.
  • Date of Service becomes:. Dependent on billing party (proceed).
  • Who is required/allowed to bill for the testing? Reference Lab Allowed to bill patient's insurance.
  • Is the Reference Lab willing to bill patient directly? Yes. Yes, but Ref Lab Test Requisition is marked to bill SHMC. No.
  • Proceed to next Steps? Proceed.
  • Decision Point Responsible Billing Party (Hospital or Patient). Bill Patient Insurance.
  • *RedCap Pass Through Sendouts.
  • Proceed to next steps? *Send test out, and mark requisition to "Bill SHMC/Client" *Send paperwork to Sendouts Supervisor for UM tracking.
  • Decision Point Responsible Billing Party (Hospital or Patient). Bill Hospital/Client (SHMC).
  • * Order in Cerner *RedCap Misc Sendouts Tracking *Follow DOS Rule Chart.
  • Proceed to next steps? 1) Send test out, and mark requisition to "Bill SHMC/Client" 2) Send paperwork to Sendouts Supervisor for UM Tracking.
  • Decision Point Responsible Billing Party (Hospital or Patient). Bill Hospital/Client (SHMC).
  • * Order in Cerner *RedCap Misc Sendouts Tracking *Follow DOS Rule Chart.

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