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Self-Ordered Tests

United Clinical Laboratories, INC.

I. PRINCIPLE:

United Clinical Laboratories provides limited testing without a physician’s written order. A separate account “Self Ordered Test” (SOT) has been created to accommodate this testing. Tests available are Urine Beta hCG, Cholesterol, Lipid Panel and second opinion Alcohol (blood).

Testing is done on a cash (or check) only basis and therefore no insurance is filed. Cholesterol and Lipid Profile results are mailed to patients with interpretation sheets, when applicable.

Beta hCG (pregnancy) test results may be mailed or phoned at the preference of the patient. Second opinion Alcohol results are only given to the patient in person.

II. PROCEDURE:

SOT Only:
Cholesterol or Lipid Profile

Beta hCG

Alcohol

SOT Combined with Physician Orders

Note: Send a copy of the receipt on all Self-Ordered Tests to the Insurance/Billing Dept at Cathedral Square along with the money collected.

  1. Cholesterol or Lipid Profile:
    1. Instruct the patient to complete the green “Blood Lipid Screening” form. Type a return envelope to the patient.
    2. Order the appropriate test(s). Refer to “Patient Registration” and “Order Registration” in CLICS Policies & Procedure.
      1. Ordering Physician: select “Not Required” from the physician drop-down list.
      2. Order By account: type in “SOT” and press enter or select “Self Ordered Test” from the account drop-down list.
      3. Bill To account: type in “SOT” and press enter or select “Self Ordered Test” from the account drop-down list.
        Note: It is very important that the “Bill To” is entered as the account “Self Ordered Test” (SOT). This account is set up in such a way that a UCL statement is not generated and therefore the testing does not follow through the normal billing process. The accumulation of frequency data and accounting for money received occurs. This account selection also triggers a special report footer that includes the patient address.
    3. Verify that ALL of the following information is correct:
      1. Patient Demographics:
        1. Patient Name
        2. Patient ID (Refer to “Patient Registration” Generate Patient ID in CLICS Policies & Procedure for assignment of patient ID number.)
        3. Address
        4. Date of Birth
        5. Sex
        6. Phone Number
        7. Physician: Not Required
      2. Bill To Information: Self Ordered Test (SOT)
      3. Order By Information: Self Ordered Test (SOT)
      4. Test Ordered: Cholesterol or Lipid Panel, (106 or 785 respectively)
    4. Making Corrections:
      1. Demographic information changes are made through the Patient Registration screen. Refer to “Patient Registration” in CLICS Policies & Procedure.
      2. Bill To information changes are made through the Order Maintenance screen. Refer to “Order Maintenance” in CLICS Policies & Procedure.
      3. Wrong test ordered:
        1. If results have not been released, delete the test through the Delete Test screen and reorder through the Order Registration screen. Refer to “Delete Test” and “Order Registration” in CLICS Policies & Procedures.
        2. If result have been released, refer to “Ordering Error, Handling” in CLICS Policies & Procedures.
    5. File the “Blood Lipid Screening” form at the ordering site by date of service.
    6. Money collected for the test is sent to the UCL Cathedral Square Business Office. Include the patient name, date & time of order and test(s) ordered with the payment.
      Note: A print screen of the Order Maintenance Screen for the self-ordered test(s) will suffice for this documentation.
  2. Beta hCG Test (urine):
    1. Order the test. Refer to “Patient Registration” and “Order Registration” in CLICS Policies & Procedure.
      1. Ordering Physician: select “Not Required” from the physician drop-down list.
      2. Order By account: type in “SOT” and press enter or select “Self Ordered Test” from the account drop-down list.
      3. Bill To account: type in “SOT” and press enter or select “Self Ordered Test” from the account drop-down list.
        Note: It is very important that the “Bill To” is entered as the account “Self Ordered Test” (SOT). This account is set up in such a way that a UCL statement is not generated and therefore the testing does not follow through the normal billing process. The accumulation of frequency data and accounting for money received occurs. This account selection also triggers a special report footer that includes the patient address.
    2. Verify that ALL of the following information is correct:
      1. Patient Demographics:
        1. Patient Name
        2. Patient ID (Refer to “Patient Registration” Generate Patient ID in CLICS Policies & Procedure for assignment of patient ID number.)
        3. Address
        4. Date of Birth
        5. Sex
        6. Phone Number
        7. Physician: Not Required
      2. Bill To Information: Self Ordered Test (SOT)
      3. Order By Information: Self Ordered Test (SOT)
      4. Test Ordered: Beta hCG, Urine (224)
    3. Making Corrections:
      1. Demographic information changes are made through the Patient Registration screen. Refer to “Patient Registration” in CLICS Policies & Procedure.
      2. Bill To information changes are made through the Order Maintenance screen. Refer to “Order Maintenance” in CLICS Policies & Procedure.
      3. Wrong test ordered:
        1. If results have not been released, delete the test through the Delete Test screen and reorder through the Order Registration screen. Refer to “Delete Test” and “Order Registration” in CLICS Policies & Procedures.
        2. If result have been released, refer to “Ordering Error, Handling” in CLICS Policies & Procedures.
    4. If the patient prefers to phone for results and not have a report sent to them, notify the Cathedral Square Business Office to destroy the report.
      Note: This can be a very sensitive issue. Make sure that the patient’s wishes are carried out.
      If the patient would like results sent, type a return address envelope and send to the Cathedral Square Business Office.
    5. File the requisition at the ordering site by date of service.
    6. Money collected for the test is sent to the UCL Cathedral Square Business Office. Include the patient name, date & time of order and test(s) ordered with the payment.
      Note: A print screen of the Order Maintenance Screen for the self-ordered test(s) will suffice for this documentation.
  3. Blood Alcohol (second opinion):
    Note: Fax a copy of the order to the office at Cathedral Square, noting the amount collected so pricing can be verified with billing.
    1. Iowa Code Section 321J.11 allows for a person arrested for OMVUI, on the basis of a breath test, to have the opportunity to have an “independent chemical analysis” administered at the individual’s own expense. These individuals will be brought to the laboratory and identified by a police officer or by photo identification card.
    2. Laboratory staff will perform testing without a physician’s order, handling the specimen as a “legal” blood alcohol. In this case though, no signed request or consent form is required. Complete the UCL Out Patient Requisition (OF95 or OF95B).
      Note: Refer to the “
      Ethanol; Beckman DXC600” procedure, section XII. Legal Blood Alcohol protocol, for instruction on specimen handling and chain of custody.
    3. Payment for the test and drawing fee is required before the sample is drawn. Order the Whole Blood Ethanol Test (code 593) and venipuncture fee (code 601). See 3.E. Consult the 3rd Party Price List for Ethanol (593) and Venipuncture (601) to charge the individual for the correct dollar amount.
      Note: Special pricing has been assigned to the Self Ordered Test account for Ethanol, Whole Blood.
    4. Inform the individual that the results may be picked up at the UCL Cathedral Square site after 3:00 P.M. the next day, if the specimen is drawn Sunday through Thursday. If the specimen is collected Friday or Saturday, the results will not be available until 3:00 P.M. on Monday. The report will only be given to the individual, in person. Identification must be made via photo ID.
    5. Order the test(s). Refer to “Patient Registration” and “Order Registration” in CLICS Policies & Procedure.
      Refer to “
      Patient Registration” Generate Patient ID in CLICS Policies & Procedure for assignment of patient ID number.
      1. Ordering Physician: select “Not Required” from the physician drop-down list.
      2. Order By account: type in “SOT” and press enter or select “Self Ordered Test” from the account drop-down list.
      3. Bill To account: type in “SOT” and press enter or select “Self Ordered Test” from the account drop-down list.
        Note: It is very important that the “Bill To” is entered as the account “Self Ordered Test” (SOT). This account is set up in such a way that a UCL statement is not generated and therefore the testing does not follow through the normal billing process. The accumulation of frequency data and accounting for money received occurs. This account selection also triggers a special report footer that includes the patient address.
    6. Verify that ALL of the following information is correct:
      1. Patient Demographics:
        1. Patient Name
        2. Patient ID (Refer to “Patient Registration” Generate Patient ID in CLICS Policies & Procedure for assignment of patient ID number.)
        3. Address
        4. Date of Birth
        5. Sex
        6. Phone Number
        7. Physician: Not Required
      2. Bill To Information: Self Ordered Test (SOT)
      3. Order By Information: Self Ordered Test (SOT)
      4. Test Ordered: Ethanol, Whole Blood (593)
    7. Making Corrections:
      1. Demographic information changes are made through the Patient Registration screen. Refer to “Patient Registration” in CLICS Policies & Procedure.
      2. Bill To information changes are made through the Order Maintenance screen. Refer to “Order Maintenance” in CLICS Policies & Procedure.
      3. Wrong test ordered:
        1. If results have not been released, delete the test through the Delete Test screen and reorder through the Order Registration screen. Refer to “Delete Test” and “Order Registration” in CLICS Policies & Procedures.
        2. If result have been released, refer to “Ordering Error, Handling” in CLICS Policies & Procedures.
    8. File the requisition at the ordering site by date of service.
    9. Money collected for the test is sent to the UCL Cathedral Square Business Office. Include the patient name, date & time of order and test(s) ordered with the payment.
      Note: A print screen of the Order Maintenance Screen for the self-ordered test(s) will suffice for this documentation.
  4. If the outpatient has a physician order for a test and also wants one of the SOTs drawn at the same time to save a venipuncture, two separate orders must be placed, one for the SOT and one for the physician ordered test(s).
    1. Place the order for the Self Ordered Test(s) following the SOT CLICS procedure. The Ordered by and Bill to is “SOT”, the physician is “Not Required”. The venipuncture is included in the fee so do not order or collect money for a venipuncture for SOTs.
    2. For additional testing with a physician order, a separate order must be placed.
      1. The Ordered by for this test is OP and the Bill to can be either OP or Insurance if the patient wants insurance filed for the physician ordered tests. (UCL does not file insurance for SOT tests.)
      2. The ordering physician’s name must be used in the Ordering Physician field.
      3. A venipuncture charge is also added.
    3. Payment:
      1. Collect cash or check for the Self Ordered Tests.
      2. If the outpatient want to pay cash for the additional testing ordered by a physician, check the current fee on the OP/3rd Party Fee Schedule and include the fee for venipuncture.
      3. UCL will file insurance or bill the patient for the physician ordered test(s) if this is the patient’s preference. Only the Self Ordered Test must be paid for at the time of collection.
    4. Reporting:
      1. Two separate orders must be placed in these circumstances to reporting will occur correctly.
      2. Two reports will print:
        1. One report will print for the SOT(s), Physician Not Required, which will be sent to the patient.
        2. A second report will print for the physician ordered test(s). This report will indicate the ordering physician’s name and include only those tests that were ordered by the physician. This is important so the report for the physician ordered test(s) match the physician order documented in the patient’s medical record.

       

    1. 6/10/97 M.J. Bonifas
    2. 7/8/98 M.J. Bonifas (Revised: II.3. added)
    3. October 2000 R. Maiers/M. English (Revised: format, II. 1.F.note, 2.F.note, 3.C.&I.notes)
    4. October 2003 S. Hosch (Revised: use of pseudo-number removed)
    5. April 2004 M. English (Revised: II. Note, 1.D.c., 2.C.c., 3.Note & 3.G.c.)
    6. February 2007 R. Schaefer (Revised: II.3.D. omit SSN)
    7. November 2010 M.J. Bonifas (Revised: II.4. added)

       

Comprehensive Review:

       

    Administrative Director:

    Technical Director:

       

Interim Review:
November 2010 S. Hosch (Revised: II.3.C.)
December 2011 K. Gourley (no changes)

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