Granger Genetics is committed to complying with all federal and state rules and regulations; accordingly, we are providing you with this Annual Notice to Physicians statement. This information can also be found on our parent company website at www.grangergenetics.com and on our Physician portal. If you have any questions about these regulations or our services, please call Client Services at 844.347.2643.
- Medicare will pay only for those tests that meet the Medicare coverage criteria, and are reasonable and necessary to treat or diagnose a patient. The Centers for Medicare and Medicaid Services has developed National Coverage Determination (NCD) guidelines that can be referenced at http://www.cms.gov/medicare-coverage-database/.
- Local Coverage Determinations (LCD) is a policy created by the Medicare Administrative Contractor (MAC) for each region. These guidelines may supplement or be in addition to the NCD guidelines. These guidelines can be referenced at http://www.cms.gov/medicare-coverage-database/.
- Medicare regulations prohibit the laboratory from billing the patient for laboratory tests for which the International Classification of Diseases (ICD10) code(s) indicated by the physician do not support medical necessity unless an Advance Beneficiary Notice (ABN) has been properly signed by the patient. It is the physicians’ responsibility to ensure that the ABN is signed and sent with the test requisition.
- Medicare payments to laboratories are based in part on each patient’s principal and secondary diagnoses, as attested by the ordering physician by virtue of his or her signature on the test request. Anyone who misrepresents, falsifies, or conceals essential information required for payment of Federal funds, may be subject to fine, imprisonment, or civil penalty under applicable Federal laws.
- Physicians or other individuals authorized by law to order laboratory tests, who knowingly cause a false claim to be submitted to any federally funded program, may be subject to sanctions or remedies available under civil, criminal and administrative law.
- By signing the test requisition, a physician is attesting to the fact that the submitted test request is reasonable and necessary and they have received no inducement to order any test from Granger Genetics.
- The physician or authorized ordering staff should be aware that the clinical laboratory has the services of a clinical consultant available to ensure proper test ordering. A clinical consultant may be reached at 888-785-8789.
- Physicians and other authorized ordering parties should only order those tests they believe are medically necessary for their patients.
- Claims for reimbursement are submitted only for tests that have been both ordered and performed. If the laboratory receives a specimen without a completed and signed test order or with an ambiguous order subject to multiple interpretations, the ordering physician will be contacted to determine what test(s) are to be performed before testing is conducted or a claim for reimbursement submitted.
- The ordering individual is aware that the clinical laboratory may only bill Medicare for testing ordered by a licensed physician or other individuals authorized by law to order clinical laboratory tests.
- Testing will only be performed with receipt of a completed and signed Granger Genetics test requisition form. If relevant diagnostic information is not provided at the time the service is ordered, testing may not be completed until the required information is obtained. Physicians are required to provide information for billing and medical necessity when requesting tests and other documentation as necessary.