2003 Press Release Index

AMS To Implement A New Universal Test Request Form For All Payors

June 9, 2003
AFFILIATED MEDICAL SERVICES LABORATORY, INC.
WICHITA, KANSAS
FOR IMMEDIATE RELEASE

AMS TO IMPLEMENT A NEW UNIVERSAL TEST REQUEST FORM FOR ALL PAYORS –
MEDICARE, MEDICAID, CLIENT, PATIENT

Dear AMS Client:

As our current inventory of test request forms, both Medicare and Non-Medicare are depleted, you will be replenished with the New All Payor Universal Test Request Form. We have now combined the two request forms into a single form and still retained the features of both previous forms. The new Universal Form can be used when ordering tests on Medicare/Medicaid patients as well as for tests that are to be billed back to the client, or directly to the patient. The form retains the add-on feature for use on non-Medicare patients only, as in the past. We have also eliminated the attached Advance Beneficiary Notice (ABN), and are now providing the new CMS-R-131-L ABN in separate padded three part sets in order to comply with Federal mandates (see AMS New Regulations) dictating size of type, verbiage, copies for distribution, and preprinting the NCDs and LMRPs on the ABN. As an additional aid we are printing on every Universal request form as well as the separate ABN, exact, easy to follow steps in executing the ABN when required. Correct and compliant utilization of the ABN continues hold high priority for enforcement by the Center for Medicare Services (CMS), and it is our hope that the re-design will assist AMS clients in achieving even greater levels of compliance with regard to ABN execution.

As clients begin requesting forms, and they are sent, you should discard all old Medicare and Non-Medicare forms, (except the Pap smear/Histo form which remains the same, and unchanged) and begin using the new Universal Form and the new separate padded ABN immediately. Clients should carefully review the new form, front and back, and read the attached instructions on completing for the various billing options, and generally become familiar with all aspects of the form. Remember, CMS, and government regulatory agencies view the test request form as a legal document, and it continues to be one of the first documents reviewed in any investigation of physicians or laboratories. Do not take the request form or the ABN lightly! Be precise, legible, accurate, and complete all required information pertinent to the billing method you have requested on the form.

This change will simplify several aspects of test requesting, and reduce the burden of inventorying multiple order forms. Further, AMS believes it has met, and exceeded the government requirements placed on laboratories to educate clients, provide clear and concise request forms, and provide the physician with a wide array of choice. With this change, if you have particular concerns or questions about using the new Universal Form, please contact Client Services at 316-265-4533 or toll free at 800-876-0243, and your questions will be answered.

PLEASE NOTE:

When converting to the new all-payor universal test request form, YOU MUST ALWAYS CHECK ONE OF SEVERAL BILLING PREFERENCES GIVEN AT THE TOP OF THE FORM, SECTION (A). If you checked MEDICARE, YOU MUST INDICATE IF MEDICARE IS THE PRIMARY PAYOR BY CHECKING EITHER THE YES or NO BOX. Additionally, if you request that AMS fax results to another facility, and have provided the fax number to AMS, you must attest that you have HIPAA authenticated the fax number by checking the yes box located directly under the peel-off ID labels.

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