FAQ's about Request Forms
Why were the forms revised?
- The forms were revised in part to speed up specimen processing. One of the biggest causes for delays in processing has been problems with billing or registration information.
Why do you ask for the patient's mother's first name?
- Our institution-wide patient registration and billing system requires it, rather than the more usual mother's maiden name. We need to enter all patients into that system in order to properly bill them. The information also helps us to avoid confusing patients with similar names.
Why do you ask for the patient's marital status and race, and how did you choose the race categories?
- The categories are determined by the institution-wide patient registration system. Having this information helps to uniquely identify the patient in some cases. Marital Status information occasionally affects insurance eligibility and billing issues.
What do you mean by primary and secondary insurance?
- Some patients have, for example, Medicare plus a supplemental insurance. If the patient has two or more insurance policies, check off the one that we should bill first in the 'primary insurance' line, and check off the other(s) in the 'secondary insurance' line. Be sure to add the billing address and name of all insurance companies other than Medicare and Medicaid.
What's a SPAN? Why can't you bill patients directly without it?
- The SPAN (Self-Pay Authorization Number) was implemented to prevent us from billing the patient directly when he or she has insurance. As we all know, it's confusing and annoying to be billed for something that should be covered by our insurance -- especially for your patients of yours who may not even be aware that their specimens were sent to our laboratory. Often, by the time the problem is identified and the bill is sent to the proper insurance company, it is too old, and the insurance company will no longer pay for it.
What's an ABN form?
- The Advance Beneficiary Notice, or ABN, is a Medicare form required in certain circumstances, including routine Pap tests. The form itself is available here, and further information about it is available on Health and Human Services' Quick Reference Guide.
Can I just staple a copy of our registration printout to the request form? It has all the information you ask for.
- While we would prefer that you copy all the information onto our form, we recognize that it would save you time to staple a copy of, for example, the patient's insurance information and submit that. If you choose to do this, please make certain that ALL the information from our form is on yours, and that any abbreviations or codes are completely spelled out.
- The request form is a legal document, much like a prescription form or any other physician order, so please make sure that the request form itself has at least the patient's name, address, and SSN entered on it, and that the form is signed by a physician.
When I click on the link, I can't see the form, or it doesn't look right. What do I do?
- First of all, don't panic. The problem is usually either that you don't have the Adobe® Reader® installed on your computer; or, if you do, you have an older version of it. You need version 5.0 or later. This software is free, and it should be very simple to install. Click here and follow the free download instructions.
- If you continue to have problems, notify the webmaster by clicking here and call Lamar Jones at (336) 716-2644 to have him mail you some forms.
How do I save the forms to my computer?
- There is a green 'SAVE' button on the bottom of the form. When you click it, you'll get a box that says 'Save a Copy..' at the top. There will be a line near the top ('Save in:') that lets you decide where on your computer to save it. The file or object name (apreqform.pdf, or dermreq.pdf) will appear near the bottom of the box; you can leave that or change the name to something that you will find easier to remember (though you must leave .pdf in place). Then click on the 'save' button in the lower right corner of the window, and you will save the form to your computer. You will still be able to type into the fields and print it out whenever you need it.
How do I print the forms?
- There is a green 'PRINT' button at the bottom right-hand corner of the form. When you click on it, a 'print' window comes up; just click OK and you will print one copy. If you want to print more copies, there is a section in that window called 'copies and adjustments' that allows you to specify the number of copies you want.
- Time-saving tip:Enter your Clinic/Group address and contact information, etc. in the Client Information section before you print the blank form or before you save it to your computer.
How do I fill in the forms online?
- When you have the form on your screen, you can place your cursor in any field and start typing. Use the cursor or the tab button to go to the next field. Fields that require you to check a box can be completed with a mouse click or by tabbing into the box you want to check and hitting 'enter.' There is a green 'CLEAR' button at the bottom of the page, which you can click at any time to delete all entries and start over. Unless you save the completed form to your computer, nothing is ever saved on this form.
Do I have to type or complete the forms online?
- It's not necessary. You can print out copies of the blank form and fill them in with a pen. Not a problem.
Can't I just submit the forms online? Where is the Submit Form button?
- No. There is no 'SUBMIT FORM' button because the form has to be attached to the specimen you're sending it with.
Can you just mail me some of the blank forms?
- Of course! You can call Meghan Shapiro at 336-716-2652 and ask for some request forms, or you can email Meghan Shapiro. Be sure to include your name, your clinic/group name, address, city/state/zip, fax number and phone number so that he can print out the forms with that part already complete.
Are collection date and time important?
- Yes! We need to know when the specimen was actually taken from the patient in order to evaluate the results.
What happens if I leave something off the form?
- Your specimen will be delayed. Specimens with completed request forms are processed immediately. Forms with missing information are given to billing personnel who have to complete the forms before the specimens can be processed.
Why does a doctor have to sign the form?
- Because the request form, like a prescription or any other physician order, is a legal document, and becomes part of the patient's chart.
What is the normal turnaround time for cytology and surgical specimens?
- We normally process specimens within 48 hours after accession into our system (excluding weekends).
Do you accept 'ThinPrep' GYN preps even though 'SurePath' preps are the method of choice at WFBMC?
- Yes, we do! The specimens are processed off-site, but stained and evaluated by WFBMC staff.
Why are chief complaint and other clinical findings important? Do you need to know the ICD-9 Codes?
- Chief complaint and clinical findings help us determine the proper billing (ICD-9) code. We need to know why, for example, it's necessary to rule out cancer. Is there a lump somewhere? A spot on an X-ray?
- If you know the ICD-9 code, you can write it in the 'chief complaint' space for surgical and dermatological specimens, or in the 'any other pertinent information' space for cytology specimens, but it's not necessary for you to look it up.
Where can I find a price list for all the tests you offer?
- You can call Meghan Shapiro at 336-716-2652 and she can send you a list.
Some Helpful Definitions
That's you: the lab, hospital, or practice group sending us a specimen
Whose insurance policy is it? (e.g. the patient's own policy; or the patient's spouse or parent)
Primary vs. Secondary Insurance
Primary = company that should be billed first. Secondary (if any) = company that should be billed for anything not covered by primary insurance.
SPAN (Self-Pay Authorization Number
Call 336-713-0164 or 716-9817 to have SPAN assigned when the patient is to be billed directly. We can not bill patients directly without pre-authorization.
ABN (Advance Beneficiary Notice Form
See the HHS Quick Reference Guide here. These forms are required for certain procedures performed on Medicare patients. Once completed, the form is kept on file in your office. You do not need to send it to us
Primary Care Provider (PCP)
Patient's regular Physician, Physician Assistant, Nurse Practitioner, etc. (if this is someone other than the person signing the request).