Laboratories & Pathology: Compliance

Are you a Medicare or Medicaid patient? Find out what tests and laboratory services are covered.

ProMedica Laboratories adheres to all federal and state law and program requirements for Medicare, Medicaid and private health care plans.

• Medical necessity is the foundation for the provision of laboratory services. Medicare will pay only for tests that meet the Medicare coverage criteria and are "reasonable and necessary" to treat or diagnose an individual patient.
• Medicare generally does not cover routine screening tests even if the physician or practitioner considers the tests appropriate for the patient.
• An Advanced Beneficiary Notice (ABN), signed by the patient prior to his specimen being collected, allows ProMedica Laboratories to bill the patient directly for laboratory services that Medicare does not pay.
• All components of an organ/disease panel must be reasonable and necessary otherwise individual tests should be ordered.
• Tests that require specific diagnoses for Medicare payment are noted on the ProMedica Laboratories Clinical Requisition form.
• Physicians who order diagnostic tests must provide to the supplier the diagnostic or other medical information required in order for Medicare payment to be made. Medicare payment is facilitated when the most complete and detailed diagnosis information is provided. ProMedica Laboratories prefers that the ordering physician sign the laboratory requisition (handwritten or electronically). (However, because Medicare does not require the signature of the ordering physician on a laboratory service requisition, the physician may document and authenticate the ordering of specific lab services in the patient's medical record.)
• Reflex testing is automatically performed when initial results are outside normal parameters and indicate that another related test is medically appropriate. The reflex test list is reviewed and approved by ProMedica Laboratories Medical Directors and ProMedica Medical Executive Committees. See "Reflex Testing Policy" in the ProMedica Laboratories Specimen Collection Manual/Test Catalog.
• Annual Medicare Notice
• Some preventive screenings are covered; view Medicare's preventative services chart for details.
• Ordering of supply policies
• Release of Lab Results to Patients

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