Effective Tuesday, June 19, 2012, there will be changes in the prompts and warnings associated with mailout tests.  These changes are designed to remove prompts associated with frequently ordered mailouts and focus instead on those with high-cost, slow turnaround, and potential for reflex testing.  The intent is to provide more transparent information to ordering providers in the charges associated with tests and also those tests with long turnaround time.

This can guide decisions on whether testing will be available in time to affect clinical decision-making for inpatient encounters and to ensure that patients and providers are aware of high-cost tests.  Note that on inpatient encounters, most reimbursement is by diagnosis related group (DRG) without specific coverage of diagnostic testing.  Also, patients can incur significant financial liability from charges associated with inpatient encounters, especially if insurance coverage involves high deductible or co-insurance coverage models.

A summary of the changes in Epic is as follows:

1. The general prompt (shown below) currently associated with all mailout tests is being removed.  "Mailout testing requires review and approval from a staff physician.  Has this testing been authorized by a staff physician?"

2. High priced testing warnings are now applied to all mailout tests that involve charges of $250 of higher.  These are in the following categories in the table below.

High-priced Warning	Charge Range Associated with that Test
> $250	$250 - $499
> $500	$500 - $749
> $750	$750 - $999
> $1,000	$1,000 - $1,499
> $1,500	$1,500 - 1,999
> $2,000	$2,000 - 2,999
> $3,000	$3,000 - 3,999
> $4,000	$4,000 - 4,999
> $5,000	$5,000 - 5,999
> $6,000	$6,000 - 7,999
> $8,000	$8,000 - 8,999
> $9,000	$9,000 - 9,999
> $10,000	$10,000 - 17,999
> $18,000	> $18,000

3. Slow turnaround time warnings are now applied to all mailouts with expected turnaround time exceeding 1 week.  These are based typical turnaround times provided by the reference laboratory.

Slow Turnaround Time Warning	Turnaround Time Associated with that Test
> 1 Week	1-2 Weeks
> 2 Weeks	2-3 Weeks
> 3 Weeks	3-4 Weeks
> 4 Weeks	4-6 Weeks
> 6 Weeks	6-8 Weeks
> 2 Months	2 – 3 Months
> 3 Months	> 3 Months

4. The following warning prompt is now associated with selected mailout tests:  "Depending on results on initial testing, the reference laboratory performing this test can initiate further reflex testing that will involve additional charges for the patient."

Examples of tests that will contain this warning are "PARANEOPLASTIC AUTOANTIBODY EVALUATION" (LAB3800) and "EPILEPSY SCREEN REFLEXIVE" (LAB5809).  Note that in some cases, the reflex testing can increase charges by ten-fold, especially for testing that reflexes to full sequencing of genes.

Questions should be directed to Matthew Krasowski, MD, PhD, medical director of the Clinical Chemistry Laboratory (384-9380, matthew-krasowski@uiowa.edu).