Staff Portal
Apollo Laboratories, its affiliates and related organizations (collectively, the “Organization”) hereby agree to grant me, the undersigned, access to the Organization’s online portal and access to certain medical information and data (the “Portal”), subject to and contingent upon the terms set forth below. In exchange for the grant of access, and as a continuing obligation to maintain limited access to the Portal, I, the undersigned, by my signature below, hereby acknowledge and agree to abide by the following terms, conditions and rules:
DOCUMENTATION AND RECORD KEEPING REQUIREMENTS Ordering the Service The physician (or qualified provider) who orders the service must maintain documentation of medical necessity in the beneficiary's medical record. Submitting the Claim The entity submitting the claim must maintain the following documentation: - The documentation that it receives from the ordering physician or NPP practitioner. - The documentation and the information that it submitted with the claim accurately reflects the information it received from the ordering physician or NPP. Requesting Additional Information The entity submitting the claim may request additional diagnostic and other medical information to document that the services it bills are reasonable and necessary. IF the entity requests additional documentation, it must request material relevant to the medical necessity of the specific test(s), taking into consideration current rules and regulations on patient confidentiality. CLAIMS REVIEW Documentation Requirements Upon request by CMS, the entity submitting the claim must provide the following information: contact the ordering physician or NPP). - Documentation showing accurate processing of the order and submission of the claim. - Diagnostic or other medical information supplied to the laboratory by the ordering physician or NPP, including any ICD-10-CM code or narrative description supplied. Services that are NOT Reasonable and Necessary If the documentation does not demonstrate that the service is reasonable and necessary, CMS takes the following actions: - Provides the ordering physician or NPP information sufficient to identify the claim being reviewed. - Requests from the ordering physician or NPP those parts of a beneficiary's medical record that are relevant to the specifuc claim(s) being reviewed. - If the ordering physician or NPP does not supply the documentation requested, informs the entity submitting the claim(s) that the documentation has not been supplied and denies the claim. PHYSICIAN ACKNOWLEDGEMENT I understand that as a policy, Apollo Laboratories provides convenient options for clients and assists in the best patient care possible. Apollo offers custom panel options to all of their physicians. This panel allows each physician to any combination of individual tests. I certify that the tests ordered are medically necessary. I agree to contact Apollo time if needed. I understand and agree to the statement above. I authorize Apollo Laboratories to perform the custom panel that I have designated on this form, as I authorize it for my patients and their order forms. At any time, I can modify my custom panel by contacting Apollo and may also order individual tests on any specimen. I understand and agree to the Physician Acknowledgement and Authorization Statement above.
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