Policies—Cape Cod Healthcare Laboratory Services

Add-On Tests • Current address Many tests may be ordered after initial collection of a • Telephone number specimen and added to the original specimen. In this • Social Security number case, the test will be run and reported providing that • Insurance company name and address specimen requirements are met and the physician has • Insurance group name or number provided a diagnosis that will support the added test • Secondary insurance carrier name and address request. If specimen integrity would be compromised in • Diagnosis code any way, the ordering provider will be notified that a new specimen must be obtained. Providing this information will avoid additional correspondence with your office at some later date. A Critical Value Reporting copy of all insurance cards is appreciated. Please advise your patients that they will receive a bill for laboratory Critical test values have been established and approved services from Cape Cod Healthcare Laboratory by the Medical Executive Committee for Cape Cod Services at Cape Cod Hospital. VISA® and Healthcare. When a test is flagged as critical in Cape MasterCard® are acceptable forms of payment. Cod Healthcare Laboratory Services’ information system, the ordering physician, or covering physician when appropriate, will automatically be contacted Cancellation of Tests immediately with the result. Cancellations received prior to test setup will be honored at no charge. Requests received following test Authority to Order Test setup cannot be honored. A report will be issued automatically and charged appropriately. In the state of Massachusetts, analysis and/or examination of specimens is permitted by written Competitor Disclaimer request of a licensed physician, dentist, osteopath, chiropractor, nurse practitioner, physician’s assistant or As to tests that are identified as being performed by other person authorized by Massachusetts General Law parties other than Mayo Medical Laboratories or Cape (M.G.L). Cape Cod Healthcare Laboratory Services Cod Healthcare Laboratory Services, the information requires that all phone orders be followed up regarding such tests was obtained from the test immediately be a faxed order signed by an authorized provider’s most recent available catalog, as provider. supplemented by any additional information provided to Cape Cod Healthcare Laboratory Services or Mayo Billing Medical Laboratories by the test provider. Neither Cape Cod Healthcare Laboratory Services nor Mayo Medical Client—Each month our clients will receive an Laboratories warrants or endorses the timeliness or itemized invoice/statement which will indicate date of accuracy of any such information. If you have any service, patient name, test name, and test charge. concerns or questions about the timeliness or accuracy Payment terms are net 30 days. When making of such information, you should contact that provider payment, please include our invoice directly. mnemonic/number on your check to ensure proper credit to your account. Confidentiality of Results Medicare/Medicaid—Direct billing must be applied to Cape Cod Healthcare Laboratory Services endeavors to all patients covered under Medicare or Medicaid maintain confidentiality of all patient information. To insurance. Please ensure that appropriate ensure the appropriate release of patient results in Medicare/Medicaid insurance information is also response to telephone inquiries, appropriate provided. identification of your office staff is required.

Patient and Third Party—The following billing Esoteric Tests and Reference Testing information is required: Cape Cod Healthcare Laboratory Services refers tests that are esoteric in nature to only those laboratories • Responsible reputable for excellent quality in both their test party methodologies and services. Mayo Medical • Patient’s name Laboratories of New England and Rochester, Minnesota is our primary reference laboratory. They offer a variety of technologies including DNA, PCR, and flow cytometry. In addition, Mayo Medical Laboratories offers both Cape Cod Healthcare Laboratory Services and all of our clients medical consultation and technical support regarding any test performed at their facilities. Due to the epidemiology of tick-borne diseases in the New can achieve the highest standards of care, Cape Cod England area, Cape Cod Healthcare Laboratory Services refers Healthcare Laboratory Services considers specimen integrity Lyme analyses and other Tick Borne Disease testing to a very high priority when performing all tests. Taking into IMUGEN, Inc. of Norwood, Massachusetts. consideration optimum specimen requirements, manufacturer’s recommendations, and our laboratory’s Infectious Material experiences, on occasion we will reject a specimen for testing. The Centers for Disease Control (CDC) in its regulations of Such rejections are considered when a specimen is moderately July to grossly hemolyzed, clotted, quantity of a specimen is 21, 1980, has listed organisms/diseases for which special insufficient, or specimen has been stored at a temperature that packaging and labeling must be applied. Required special may impact stability of analyte being tested. Each of the containers and packaging instructions can be obtained from us above reasons for rejection may cause inaccurate results. by using the “Request for Supplies” form. In addition Cape Cod Healthcare Laboratory Services may Shipping regulations require that infectious substances suggest specimen recollections for improper or mislabeled affecting humans be shipped in a special manner. See specimens. Specimens that are collected at the physician’s “Infectious Material” in “Special Instructions.” A copy of the office must include patient’s name, date of birth, date and regulations can be requested from the International Air time of collection, and initials of person who collected Transport Association (IATA); they may be contacted by specimen. Name and date of birth on specimen container phone at 514-390-6770 or faxed at 514-874-2660. must match name and date of birth on requisition that accompanies specimen. Informed Consent Cape Cod Healthcare Laboratory Services assumes that the When a specimen is being rejected at Cape Cod Healthcare ordering physician has obtained “Informed Consent” of the Laboratory Services, our Customer Service Technicians are patient as required by state or federal laws with respect to each notified and in turn will notify the ordering physician with an test request. An example is HIV antibody screen testing. explanation.

Medicolegal Testing Please review the following conditions prior to submitting a Cape Cod Healthcare Laboratory Services does not perform specimen to Cape Cod Healthcare Laboratory Services: drug testing for legal purposes. • Full 24 hours for timed urine collection Patient Identification Accuracy • Lack of hemolysis/lipemia • Specimen type (plasma, serum, whole blood, etc.) Cape Cod Healthcare Laboratory Services adheres to proper • Specimen volume identification of patient specimens for good patient care, both quality and for patient safety. The need for proper • Patient information requested identification is specified by the College of American • Patient/specimen properly identified Pathologists (CAP) Laboratory General Checklist • Specimen container (metal-free, separation gel, Commentary GEN 40700: “Specimens lacking proper appropriate preservative, etc.) identification or an accompanying requisition are not • Transport medium accepted by the laboratory.” • Temperature (ambient, frozen, refrigerated)

To be compliant, it is important that each specimen be STAT Testing properly labeled with the same demographics that appear on For true STAT testing on outpatients, Cape Cod Healthcare the paperwork. If a discrepancy has been identified upon Laboratory Services suggests patients visit either Cape Cod specimen arrival at Cape Cod Healthcare Laboratory Services, Hospital’s Referred Outpatient Department or the Faxon you will be contacted to make you aware of the discrepancy Center at Falmouth Hospital. and the test will be cancelled.

Specimen Rejection Due to the nature of our outpatient business, Cape Cod Healthcare Laboratory Services cannot promise STAT turn Cape Cod Healthcare Laboratory Services is committed to around on test orders. Our Patient Service Centers send providing quality results for our patients and to physicians that specimens on average 2 to 3 times per day to our testing depend upon those results to diagnose and make treatment decisions for their patients. To ensure that we facilities at Cape Cod Hospital and/or to Falmouth Hospital. — Cape Cod Healthcare Laboratory Services Once at the testing sites, a test that is requested STAT will be cannot pay shipping and handling of run and reported promptly to the ordering physician. specimens

Supplies Note: Research studies must be approved by the Director of Cape Cod Healthcare Laboratory Services will provide Research Compliance. For information call Clinical supplies for collection, processing, and transport of specimens Research at Cape Cod Healthcare at 508-862-5812. that are referred to Cape Cod Healthcare Laboratory Services for testing. For prompt delivery of supplies, please fax orders to Inventory Supply Department at 508-539-6173.

Tests Referred Out of System Cape Cod Healthcare Laboratory Services will accommodate most special requests for specimens to be sent to laboratories out of our system providing that we have the resources available to process such specimens. A Handling Charge will be charged to the patient at the time of service for such requests. Please call Customer Service at 800-750-8378 for information. The following information must be provided in advance:

• Specimen requirements • Laboratory performing test(s) provides any special Test Turnaround Time collection kits and/or tubes This catalog lists the days on which the test is set up as a • Appropriate paperwork is completed by ordering guide to expected analytical turnaround times. Cape Cod physician Healthcare Laboratory Services performs approximately 94% • Shipping instructions, including recipient laboratory’s of our tests at our hospitals and most tests are available to account information providers within hours of being received in the laboratory. Please note: Due to electronic interfaces with our primary reference labs, — Patients may be responsible for payment at time most send out tests are available with 48 to 76 hours. of service for shipping and/or handling