Billing Information

ACS offers a variety of alternatives for billing laboratory services:

PATIENT
The Laboratory bills patients directly for laboratory services performed. As part of direct patient billing, ACS will also bill any third party insurance provided all necessary information and/or forms are included with the test requisition.

American Clinical Services (ACS) is committed to providing clinical laboratory services to all patients regardless of their ability to pay. Through our Indigent Patient Program we may adjust some or all laboratory charges for patients who are uninsured and cannot afford to pay for their clinical laboratory testing.

INSURANCE
ACS will file claims directly with Medicare and other Insurance carriers for patients who are eligible subscribers or recipients of benefits provided all necessary information and/or forms are included with the test requisition. Coverage may vary based on the patient's specific health plan benefit. Patients are responsible for payment of non-covered services, deductibles, co-payments and co-insurances, if applicable.

CLIENT
Each account is billed once a month, with charges accumulating daily as specimens are received. Notify ACS in writing of any discrepancies within 30 days. Adjustments will appear on the next invoice. ACS will bill, as permitted by state law:

• HospitalsClinical Laboratories
• Commercial or Industrial Accounts
• Trade Union Health Facilities
• Governmental Agencies
• Substance Abuse Programs

MEDICARE
The following information is required on the ACS Lab Test Requisition to file a Medicare claim:

• Patient’s Full Name (As it appears on the card)
• Patient’s Full Address (Including apartment / unit number)
• Patient’s Date of Birth
• Patient’s Social Security Number
• Medicare HIC Number (Frequently 9 digits + 1 letter)
• Requesting Physician’s Name (last, first) and UPIN (1 letter + 5 digits) as assigned by the Centers for Medicare and Medicaid Services (CMS)
• ICD-9 Diagnosis Code(s)
• Primary or Secondary Coverage under Medicare
• Patient Signature (For release of medical information)
  

The following information is optional on the ACS Lab Test Requisition to file a Medicare claim:

• Signed Advance Beneficiary Notice (ABN)

ACS will file a claim to Medicare provided that all the necessary information is included on the Lab Test Requisition.

The Office of the Inspector General (OIG) has advised clinical laboratories to remind physicians (or other individuals authorized by law to order tests) to ensure that when ordering tests for which Medicare reimbursement will be sought, they should only order tests that are medically necessary for the diagnosis or treatment of a patient rather than for screening purposes.

We urge all ordering physicians to retain in the patient's medical record and history, notes documenting the patient's conditions and diagnoses, with relevant clinical signs/symptoms or abnormal laboratory test results, appropriate to one of the covered indications. Documentation in the beneficiary's medical record must support the medical necessity of the test(s) provided. We ask that you provide us with all of the relevant diagnostic information from your medical records on all of your patients, for the dates of service that you request clinical lab testing from ACS. It is critical that the codes are as specific as possible. This means that the ICD-9-CM 4th and 5th digit subclassifications should be used in your coding.

We remind you that Medicare does not cover tests for beneficiary's annual physicals or for screening purposes. If you want to order tests for screening purposes, patients should be informed of their responsibility to pay. With the proper patient acknowledgement, you may order screening tests with one of the appropriate screening diagnosis codes.

MEDICARE ADVANCE BENEFICIARY NOTICE (ABN)
If reimbursement is denied due to lack of medical necessity documentation, Medicare rules prohibit the laboratory or health care provider from billing the patient unless an Advance Beneficiary Notice (ABN) has been signed and dated by the patient prior to the service. If applicable, an ABN must be completed each time services are ordered. A blanket ABN is not acceptable to the Medicare program.

The Centers for Medicare and Medicaid Services (CMS) has established a standardized ABN that ensures the patient understands that he/she may be responsible for payment if the test is considered to be medically unnecessary by Medicare. The ABN identifies the limited coverage laboratory test(s) and gives the reason(s) the test(s) is likely to be denied. In order for the patient to make an informed decision whether or not to receive the service, the ABN provides two options. Option 1 states that the patient chooses to have the service performed and understands that he/she is personally responsible for payment in the event Medicare denies payment. Option 2 states that the patient refuses to have the service performed and will notify his/her doctor of that decision. If a Medicare patient in an American Clinical Services' patient service center refuses to sign an ABN, the service generally will not be performed.

To comply with these new guidelines, physicians should (1) only order tests that are medically necessary in diagnosing or treating their patients; (2) be certain to enter the appropriate and correct ICD-9 code in both their patient files and on the test request forms; and (3) always have their patients sign and date an Advance Beneficiary Notice if they believe that the service is likely to be denied.

INDIGENT PATIENT PROGRAM - ELIGIBILITY
The program is available to uninsured patients who cannot afford to pay their bill.

• We will require certain information, such as your W-2 form to verify your income.
• If you are currently eligible for federal food stamps, qualify for state Medical Assistance, or are eligible for the Hill-Burton Program you will automatically qualify under our program.
• You may be required to submit proof of your eligibility for one or more of these programs.
• If you do not currently qualify for these programs we will take into account your income and family unit size based on guidelines provided to us by the US Department of Health and Human Services. These guidelines are updated on an annual basis and are available at the HHS website.
• Because of certain federal and state regulations, we cannot waive co-payments or deductibles from insurance companies. Therefore, our Indigent Patient Program is only available to patients who do not have health insurance coverage.
  

INDIGENT PATIENT PROGRAM - HOW TO APPLY
If you cannot afford to pay your bill and you are uninsured, call the telephone number listed on your invoice. Ask the Billing Representative for an ACS Indigent Patient Program application.

• Please return the application within 30 days of receipt, so that we can place your bill on hold while we make our determination



• Based on your request and financial income, we will work with you to determine whether or not you qualify for our program. We will notify you whether or not you qualify for financial assistance from ACS and indicate what portion of the invoice has been credited. If you do not qualify, we will be happy to develop a convenient payment schedule for you.