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Frequently Asked Questions

 

1.  What information is mandatory on test requisitions?

The elements necessary on the test requisition vary depending on the type of billing being done. If you are filling out a requisition for a client, or account, bill, please include the name, date of birth, sex, date and time, test being ordered, and physician. Be sure to mark the box ACCOUNT BILL, if you are completing a requisition for a direct patient bill, you must include, name, date of birth, sex, date and time, test being ordered and pertinent billing information, such as self-pay, patient insurance, Medicare, or Medicaid. Diagnosis information is necessary on all requisitions.

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2.  When must an ABN be completed?

Medicare will only pay for services that it determines to be reasonable and necessary. Every attempt must be made by the ordering physician, nursing staff, and laboratory staff to document medical necessity to ensure reimbursement from Medicare.

ABN, or advanced beneficiary notice, must be completed for testing covered under a local Medical Review Policy and which has been determined to possibly be denied for payment. A list of tests covered under LMRP can be obtained from your regional service center. For an ABN to be valid it must:

  • Be in writing
  • Be obtained prior to receipt of services
  • Clearly identify the specific service which may be denied
  • State that provider believes Medicare is likely to deny
  • Give the provider’s reason(s) for belief that Medicare may deny payment
  • Have the beneficiary sign and date form

ABN’s are NOT required for routine or screening tests, as they are never covered services, but you are encouraged to inform your clients via an ABN. You must designate a diagnosis of "screening or routine testing" on the requisition.

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3.  How do I get copies of current Local Medical Review Policies?

Local Medical Review Policies (LMRP) can be obtained from your Regional Service Center.

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4.  What happens when Medicare denies payment for a submitted claim?

When a claim is denied, it is necessary to investigate the reason. The most common reason for denial is based on inadequate documentation. Your facility will be contacted to provide the necessary information. Oftentimes, a denial is based on inaccurate or incomplete diagnosis or miscoding.

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5.  Who do I contact with a billing question or concern?

If you have a question concerning billing, please contact your regional ALN service center:

  • Aberdeen Service Center: (605) 622-5546 or 1-800-225-8537
  • Mitchell Service Center: (605) 995-2342 or 1-800-995-5591
  • Sioux Falls Service Center: (605) 322-7187 or 1-800-560-4846
  • Yankton Service Center: (605) 668-816

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