Sage Screening Program. Provider Manual

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Sage Screening Program. Provider Manual"

Transcription

1 Sage Screening Program Provider Manual Sage Screening Program Minnesota Department of Health 85 E. 7th Place, Suite 400 P.O. Box St. Paul, Minnesota (651) (phone) (651) (fax) (651) (TTY) ADA notice: if you require this document in another format, such as large print, Braille or cassette tape, call (651) Revised 2/15 1

2 Table of Contents: 1 Overview pg 2 2 Eligibility pg Covered services pg Coverage of screening services pg Coverage of treatment services pg Periodicity of covered services pg Services not covered pg 5 4 Coverage of treatment pg 6 5 Enrolling women in Sage - pg Information to be completed by the patient pg The Sage Screening Program office visit pg Re-enrolling women in the Program pg 8 6 Referring for mammograms and breast ultrasounds pg Screening mammograms pg Follow-up mammograms pg Breast ultrasounds pg 9 7. Cervical testing pg Pap Smears pg HPV High Risk DNA Panel pg Colposcopy pg Coordinating with other providers pg Referral outside the site facility pg Outpatient breast diagnostic procedure pg Tracking and follow-up pg Normal test results pg Abnormal test results pg Assisting women - pg Follow-up forms pg Rescreening pg Imaging services pg Screening mammograms pg Additional mammographic Views pg Follow-up mammograms pg Breast ultrasounds pg Breast US immediate work-up pg Short term follow-up us pg Completing the form for an US- pg Other imaging services (breast MRI, X- ray, etc.) pg Lab services pg Pap tests pg Completing the Pap form pg HPV High Risk DNA Panel pg Pathology pg Billing and reimbursement pg Basic requirements pg CPT Codes pg Rates pg Submitting claims pg Patients with insurance pg Payment pg Credits pg Remittance pg Billing technical assistance pg Patient recruitment pg Inreach pg Outreach pg Resources and tools pg Collaborations pg Special population grants pg State-wide efforts pg Professional education pg Provider agreement pg Quality assurance pg Confidentiality pg Data privacy pg Sage smoking policy pg 28 Appendix (not available on-line) A- Sage Forms and instructions A1- Sage Enrollment form A2- Sage Imaging Summary A3- Sage Pap Summary B- Provider Agreement 1

3 1. Overview The Sage Screening Program is a partnership between public health and the private healthcare system. The goal of the Sage Screening Program is to remove the barrier of cost so low to moderate income Minnesota women (age 40 and over), who are uninsured or underinsured, can receive quality breast and cervical cancer screening, free of charge. The program is funded through a cooperative agreement with the Centers for Disease Control and Prevention under the Breast and Cervical Cancer Mortality Prevention Act of 1990, as well as funds from the state of Minnesota and some private organizations. 2. Eligibility Women must meet all four eligibility criteria listed below: 1. They must be age 40 or older Exception: The Sage Screening Program services are intended for women age 40 and older. To be eligible for breast cancer screening services, a woman under 40 years of age must either demonstrate breast symptoms where it is important to rule out breast cancer as a cause (i.e. lump, bloody nipple discharge, skin dimpling, inflammation), or report a family history of breast cancer where a 1 st degree relative has had the disease (parent, sibling, or child). Women under age 40 are NOT eligible to have Pap smears or colposcopies paid for by the Sage Screening Program under any circumstances 2. They must have no insurance, or be underinsured. Underinsured refers to women who have insurance that does not fully cover the cost of screening services, have unmet deductibles or a significant co-pay (co-pays should not be collected from Sageenrolled women), or other out-of-pocket expenses. This may include patients on Medicare (especially if they do not have a Medicare supplemental policy). Note: Health Savings Accounts (HSA) administered by a Health Plan for patient s with high deductibles are not part of it s insurance coverage and Sage should pay in advance of those funds. Medical Assistance and Minnesota Care will fully pay for the services Sage would cover. Women covered by these programs don t need Sage, and should not be enrolled. 3. They must be a Minnesota resident. Women, who live in Minnesota, either year-round or seasonally, are eligible for the Sage Screening Program services if they meet the program s income and insurance guidelines. Non-Minnesota women should be referred to the Breast and Cervical Cancer Early Detection Program in their state of residence to determine eligibility for services in their own state s program. Phone numbers for other state programs can be obtained by calling

4 Non-Minnesota residents from adjacent states are eligible for the Sage Screening Program if they are between the ages of 50 and 64 and meet Sage s income and insurance guidelines. These women are NOT eligible for treatment coverage under the Minnesota Treatment Act (Section 4), and as a result of participating in Sage, may become ineligible for coverage under their state s Treatment Act. 4. Have income within the guidelines listed on the following table: Household Number 2015 Income Guidelines Monthly Income Yearly Income 1 2,452 29, ,319 39, ,185 50,225 5, , , ,785 81,425 Add for each additional ,404 Determining Household Income Use gross income, unless self-employed or farmers who should use their gross income minus business expenses. Since monthly incomes may vary, use a current or recent month s estimate of monthly income. No documentation is required. Determining Household Size All persons living in the same house and being supported by the reported income, should be included in the determination of household size. 71,025 Guidelines change yearly. Sage provides updates on its website early each year. 3. Covered services The following services are free of charge to eligible women at participating facilities: 3.1 Screening Services Office visit for breast and/or pelvic exam. Pap smear Women can receive Pap testing every 3 years Women who have had a total hysterectomy (i.e., those without a cervix), should not have a Pap test done under the Sage Program; unless 1. the hysterectomy was performed because of cervical neoplasia (CIN) or invasive cervical cancer, or 2. if it was not possible to document the absence of neoplasia or reason for the hysterectomy. Note: The medical recommendations regarding screening for women who have had a hysterectomy for CIN or cervical cancer. o Women who have had a hysterectomy for CIN disease should undergo cervical cancer screening for 20 years even if it goes past the age of 65. o Women who have had cervical cancer should continue screening indefinitely as long as they are in reasonable health. 3

5 For women who have had a total hysterectomy for non-cancer reasons, Sage supports the recommendation of a yearly pelvic along with a breast exam. Sage cannot pay for an office visit in which only a pelvic exam is done. Screening mammograms must be accompanied by a current clinical breast exam done at a Sage Screening Program participating clinic. For dates of service prior to June 30, 2009, Sage will reimburse digital mammograms at conventional CMS rates. On or after June 30, 2009, Sage will reimburse digital mammograms at the full CMS digital rate. Computer Assisted Detection (CAD) with mammography. 3.2 Diagnostic Services Diagnostic services will only be provided to Sage Screening Program participants whose initial test results indicate a need for additional evaluation to rule out cancer. Follow-up office visits o Repeat clinical breast and pelvic exams as often as clinician recommends (Sage cannot cover an office visit for a pelvic exam only) o Office visits to discuss abn. results, including surgical consultations. Diagnostic mammogram (including CAD). Breast ultrasound Fine needle aspiration (including pathology). Outpatient Breast Biopsy o Special arrangements are necessary for coverage of breast biopsies (and certain other breast diagnostic procedures) through the Sage Screening Program, whether the procedure is performed at your clinic or referred out. (refer to Sect. 10 on how to arrange biopsy coverage). Human Papilloma Virus (HPV) High Risk DNA Panel coverage: o Sage will cover a High Risk HPV DNA Panel when done to triage an ASC-US or LSIL* Pap result when the Pap was covered by Sage. This can be done either reflexively from the original Pap specimen if it was a liquid-based Pap, or by a return office visit (also covered) where the HPV sample is collected (kit to collect sample is not covered). o Sage will cover a High Risk HPV DNA Panel when done for a 12 month follow-up after a colposcopy that was indicated by an ASC-H Pap or LSIL Pap (the colposcopy result cannot have been CIN 2 or 3). o Sage will cover a High Risk HPV DNA Panel when done for a 12 month follow-up after a colposcopy that was indicated by an ASC-US Pap (the colposcopy result cannot have been CIN AND there must have been a + HPV at the time of the colposcopy). o Sage will cover a High Risk HPV DNA Panel when done at the time of colposcopy for workup of a AGC-NOS Pap result (endocervical cells). There is nothing to mark on the Sage Enrollment form for this situation, but a note should be placed in the Comments area of the form to the effect that an HPV test on a AGC-NOS Pap was collected with this colposcopy. Also a Sage HPV High Risk DNA Panel form should be sent to Sage with the same encounter Number as the Enrollment form. 4

6 * in a postmenopausal woman Colposcopy of the cervix (including biopsy and ECC/ECS) o For patients for whom there is documentation of an immediatley prior abnormal Pap smear. Endometrial Biopsy o For patients whose screening Pap smear was done under Sage. o Pap result must be: any Atypical Glandular Cell finding (Examples: Atypical Endocervical cells, Atypical Endometrial Cells, Atypical Glandular Cells, Endometrial Cells [in a woman > 40 years of age], and Adenocarcinoma). Excision of breast lesions o After a diagnosis of Fibroadenoma (FA) is established with tissue sampling (biopsy), an excision of the FA may be covered in the following instances only: 1. Hyperplasia or atypical cells on pathology 2. Large size: 5 cm or greater (can obscure a malignancy) 3. Change in size or appearance as demonstrated on 6 month follow-up 4. Not FA, but a Phyllodes tumor o Note: Sage cannot cover excision for patient comfort or aesthetic reasons 3.3 Service Periodicity: Pap smear - Sage covers Pap smears (either conventional or Liquid-based) every 3 years. Follow-up to abnormal Pap smear - Following an abnormal Pap result Sage will cover all testing or retesting according to the timeframes established in the ASCCP Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities Pelvic exam - The Sage Program will pay for an office visit for an annual pelvic exam if during the office visit: 1) a Pap smear is collected according to Sage Pap periodicity policy, 2) a clinical breast exam (CBE) is preformed or 3) both a Pap and CBE are performed. 3.4 Services not covered by the Sage Screening Program Only the services listed above are covered. Some services that are commonly billed to the Sage Screening Program, but are not covered, include: Evaluation of vaginal or vulvar lesions. Removal of cervical polyps. Blood work. Urinalysis. Pelvic ultrasounds. Endometrial biopsy done for vaginal bleeding work-up. Any type of treatment for cancer or precancerous lesions (refer to MABC). 5

7 Before providing services which are not covered by the Sage Screening Program, please inform the patient that she will be responsible for payment for these services. Sage provides a document which may be used to inform patients of services that are not covered. This can be ordered from the Sage Screening Program using Clinical Forms and Supplies Order Form or on the Sage website. For other resources available for services not covered by the Sage Screening Program, call your Regional Coordinator. Note: Medicare patients enrolled in Sage should sign the Medicare Advanced Beneficiary Notice (ABN) to enable labs and hospitals to submit claims to the Sage Program. 4. Coverage of treatment services Patients, who have been screened through the Sage Screening Program and found to need treatment for breast cancer, cervical cancer, or a pre-cancerous cervical condition, may be eligible for a program that will cover the costs of such treatment. The Minnesota Department of Human Services has established a category of Medical Assistance (MA) called MA-BC which has eligibility guidelines that are less restrictive than current MA programs. The eligibility criteria are: 1) was screened through the Sage Screening Program; 2) has no insurance to cover treatment costs (including Medicare) and 3) has an immigration status that qualifies for either federal or state MA. Please see for complete details on MA-BC eligibility. Patient application forms for MA-BC are available at the local county social services office. MA-BC also offers a Presumptive Eligibility component which allows a woman who has been screened through the Sage Screening Program and found to need treatment a 30-day period of automatic coverage, regardless of her ultimate eligibility for MA-BC. In other words, even if a woman is determined by the County to be ineligible for MA-BC (after filing an application) any treatment costs incurred during the Presumptive Eligibility period will still be covered. To learn more about this contact your Sage Regional Coordinator. 5. Enrolling women in Sage Enrolling women in the Sage Screening Program is done by having the patient complete the blue Sage Enrollment form [Appendix A1]. This form is used whether the patient is new to Sage or has been covered by the program before. Instructions for this form can be found in Appendix B1. Eligible women enroll by completing pages 1 3 of the (blue) Enrollment Form (available in both English and Spanish). The clinic assigns an encounter number which should be placed on the Enrollment form, Pap Summary, Imaging Summary and any other related Sage forms (i.e. HPV high Risk DNA 6

8 Panel form) and must appear on all related bills submitted to Sage. Encounter numbers are unique to each screening site and each visit needs a new encounter number. 5.1 Information to be completed by patient Pages 1 3 of the (blue) Enrollment form should be completed by the patient before her Sage exam. Please note that patients cannot be enrolled in Sage without a completed Permission for Release of Information with a current date. This permission provides information to the patient on how the clinic and Sage will use the information collected on the form, and it allows providers to release the required medical information to the Sage Screening Program. The Sage Screening Program complies with all state and federal data privacy laws. Sage is not a HIPAA-covered entity. 5.2 The Sage Screening Program office visit Once enrolled, the patient must have a clinical breast examination (and Pap smear, if indicated) by a clinician at a Sage Screening Program screening site before receiving a mammogram. The exam may be done by a physician, nurse practitioner, physician assistant, or nurse midwife. If breast screening isn t necessary, a cervical screening only visit is acceptable. Upon completion of the Sage Screening Program patient visit, the clinician must complete the Visit Summary portion of the blue Enrollment Form. Please review the form for completeness, enter the patient into the tracking system (please refer to Section 11 of this manual for more information about tracking system requirements), make a copy for your records, and mail the original copy to the Sage Screening Program as soon as possible. To ensure that women are tracked adequately and that bills are paid quickly, it is crucial that the Sage Screening Program receive enrollment or return visit forms within 1-2 weeks of the exam. The Sage Screening Program will not accept forms later than 6 months from the date of the office visit. 7

9 If a mammogram was ordered, it is necessary to inform the mammography facility of the patient s encounter number. This can be done either by sending the mammography facility a Sage Imaging Summary form (green) with the patients name and encounter number, or by giving them the patient s Encounter Number so they can initiate the Sage Imaging Summary form. If a Pap test was done, send the specimen to the lab with the patient s encounter number. Use the pink Pap Summary form unless alternate arrangements have been made. If a breast ultrasound was ordered, it is necessary to inform the ultrasound provider of the patient s encounter number. This can be done either by sending the ultrasound provider a Sage Imaging Summary form with the patient s name and encounter number or by giving them the patient s Encounter Number so they can initiate the Sage Imaging Summary form. 5.3 Re-enrolling women in the Sage Screening Program The Sage Enrollment form (blue) is used for all patients enrolling in Sage. If they are returning Sage patients, simply make sure to check the appropriate box on the top of the back page of the form. NOTE: Short-term follow-up services- the form is necessary to report services that occur within 6 months of the patient s initial screening, even if the patient is not seen again in the clinic. In this case, the visit date should reflect the date the follow-up service is performed, and the box checked for either breast ultrasound ordered or done this visit and/or mammogram ordered or done this visit. 6. Referring for mammograms and breast ultrasounds This section provides direction to Sage Screening sites making referrals for imaging services through the Sage Screening Program. For information for those working in mammography/ultrasound facilities and/or radiology groups, see Imaging Services in Section 12. The Sage Imaging Summary is used for all imaging. 6.1 Screening Mammograms After the screening site has enrolled the patient in Sage and completed a clinical breast exam, the screening site can schedule the mammogram and send the Sage encounter number to the imaging facility. The encounter number can be relayed to the mammography facility either by sending the (green) Sage Imaging Summary form [Appendix A2] or by providing the mammography facility the patient s encounter number when the appointment is scheduled. The ordering physician will receive their usual mammography report and Sage will also receive the patient s results. If additional imaging is desired by the radiologist, the imaging facility will fill 8

10 out an additional Sage Imaging Summary for each type of imaging service provided. Instructions for the Sage Imaging Summary form can be found in Appendix B Follow-up mammograms The Sage Screening Program will reimburse for short term follow-up mammograms that are recommended by the clinician or radiologist. If the follow-up mammogram is within 12 months of the original screening tests, another clinical breast exam in not necessary. For follow-up mammograms, a Sage Enrollment form with a new encounter number should be completed, either by the screening site or by the Imaging Service Provider (even if the patient is not seen again at the clinic). The patient s signature is not required if within 9 months of the last signature (write signature within 9 months on signature line). The mammogram date should be recorded as the visit date and the mammogram ordered or done box should be checked. A new (green) Sage Imaging Summary form needs to be completed and sent to Sage. 6.3 Breast ultrasounds Sage Screening Program will reimburse for breast ultrasounds when recommended by a clinician or radiologist for follow-up of an abnormal clinical breast exam or an abnormal mammogram. When referring a patient for an ultrasound to an imaging facility, make sure the facility has the patient s encounter number. In cases in which a repeat ultrasound (i.e. three to six months later) is recommended to follow-up on a probably benign finding, a Sage Enrollment form (even if the patient is not seen again at the clinic) with a new encounter number should be completed, either by the screening site or by the Imaging Service Provider. The patient s signature is not required if within 9 months of the last signature (write signature within 9 months on signature line). The breast ultrasound date should be recorded as the visit date and the breast ultrasound ordered or done box should be checked. A new (green) Sage Imaging Summary needs to be completed and sent to Sage. 7. Cervical screening This section provides information to Sage Screening Program screening sites for handling lab services ordered through Sage. Guidance for cytology laboratories and pathologists can be found under Lab Services in Section Pap Testing The Sage Screening site enrolls the patient in Sage and assigns an encounter number. The site then does an exam and sends the Pap slide or specimen to the lab, with the encounter number noted, on a (pink) Pap Summary form (unless other reporting arrangements have been made). The ordering physician will receive their usual Pap result and Sage will also receive the patient s result. The clinic is responsible for notifying the patient of the results. 9

11 7.2 HPV High Risk DNA Panel The Sage Screening Program reimburses for HPV DNA testing only under certain circumstances (below) and NOT as an adjunct to screening. The HPV test is done to determine the need for colposcopy. Sage will reimburse: 1. Only for the High Risk DNA Panel. 2. Only an FDA approved test can be reimbursed. 3. Only one test / person / date can be reimbursed. Sage will cover a High Risk HPV DNA Panel when done to triage an ASC-US or LSIL* Pap result when the Pap was covered by Sage. This can be done either reflexively from the original Pap specimen if it was a liquid-based Pap, or by a return office visit (also covered) where the HPV sample is collected (kit to collect sample is not covered). Sage will cover a High Risk HPV DNA Panel when done for a 12 month follow-up after a colposcopy that was indicated by an ASC-H or LSIL Pap (the colposcopy result cannot have been CIN 2 or 3). Sage will cover a High Risk HPV DNA Panel when done for a 12 month follow-up after a colposcopy that was indicated by an ASC-US Pap (the colposcopy result cannot have been CIN AND there must have been a + HPV at the time of the colposcopy). Sage will cover a High Risk HPV DNA Panel when done at the time of colposcopy for workup of a AGC-NOS Pap result (endocervical cells). There is nothing to mark on the Sage Enrollment form for this situation, but a note should be placed in the Comments area of the form to the effect that an HPV test on a AGC-NOS Pap was collected with this colposcopy. Also a Sage HPV High Risk DNA Panel form should be sent to Sage with the same encounter Number as the Enrollment form. * for a postmenopausal woman Methods for HPV Testing Liquid based Pap test: reflexive HPV High Risk DNA testing can be done on the original sample, and reported on the Pap Summary, and no second visit or new encounter number is needed. Conventional Pap smear: The woman will need to return to the clinic for HPV High Risk DNA Panel collection. Complete a (blue) Sage Enrollment form with a new encounter number. In the Cervical Information section of the Visit Summary, check: HPV Test done at this visit for prior Sage Pap with ASC-US result. Complete a Sage HPV High Risk DNA Panel form using the new encounter number assigned to this visit. Send the specimen and Sage paperwork to the lab that does your clinic s HPV testing. 10

12 7.3 Colposcopy Sage will reimburse for colposcopy (with cervical biopsy and /or histological endocervical sampling (ECC or ECB), or both). Patients must have a documented recent abnormal Pap smear indicating the need for colposcopy or a prior abnormality requiring surveillance. 8. Coordinating with other providers Because of the interdependence of all service providers working with the Sage Screening Program, a good line of communication should be established with each facility (e.g. the clinic, mammography facility, Pap lab) the screening site will be working with to coordinate care for Sage patients. This may be as simple as identifying a contact person name and phone number at each facility and holding an annual or semi-annual meeting. Each service provider has to complete their steps in the Sage Program process in order for the next step to work. The coordination established will help solve system or individual problems before they get out of hand. Sage Program staff is always available for assistance in establishing these links and resolving any problems that may occur. 9. Referral outside the Sage Screening site facility Some Sage Screening Program providers may not offer one or more of the follow-up services that the Sage program will pay for (i.e. colposcopy). When this occurs, the patient should be referred to another Sage participating facility that offers the necessary service. That facility would then enroll her under their encounter number for that service. In the instance when the only available referral facility for the service is not a Sage Screening Program provider, the referring Sage facility must make billing arrangements with the referral provider to assure that Sage Program funds will pay for the service and the woman will not be billed. 10. Outpatient breast diagnostic procedures Sage Screening Program will cover all costs normally associated with an approved outpatient breast diagnostic procedure, including surgical consultation, biopsy (whether open surgical, needle localization, or stereotactic), anesthesiology, pathology, lab work, and pre-op exam or consult. However, special arrangements must be made to bill these procedures, and prior authorization is required. The Sage Screening Program provider arranging the procedure must obtain an authorization number (M number) by contacting Sage at (651) Sage authorizes the procedure and assigns a unique (M) number to the procedure, completes the patient 11

13 information portion of the Outpatient Breast Diagnostic Procedure invoice, and mails four copies of this form for distribution. Once authorization is received, all parties involved in the procedure must be contacted and given the Sage-provided M# authorization. In no case should the patient be held responsible for any part of the bill. The Sage Program will reimburse at current Medicare rates. Upon receiving Outpatient Breast Diagnostic Procedure invoices, one copy should be distributed to each of the (billing) entities involved in providing the breast procedure, (i.e. anesthesiologist, radiologist, surgeon and hospital). Each of these entities should complete their copy of the form and submit it to Sage for reimbursement. The form should include the federal ID number of the organization to be paid and should have attached an itemized list of charges with CPT codes and any Explanation of Benefits (EOBs), if the patient has insurance. If an organization does not currently have a provider agreement with Sage, contact your Regional Coordinator to arrange it. 11. Tracking and follow-up A crucial component of the Sage Screening Program is to ensure that women with abnormal screening results, or women who have a diagnosis of cancer, receive timely and appropriate diagnostic, treatment, and rescreening services. Sage Screening sites are expected to maintain a system to enable them to track patient results, notify patients of their test results, follow-up with patients with abnormal results, and remind patients to return for rescreening Normal test results Screening sites should communicate normal test results to patients in writing or by telephone within ten days of receipt Abnormal test results Screening sites should attempt to notify a patient of an abnormal test results within 5 days of receipt. Several attempts to notify a patient should be made by phone. If you re unable to reach a patient by phone, a certified letter may be sent. All dates and attempts to reach a patient, as well as the follow-up recommendations, should be documented in the patient s medical record. The recommendations and a plan for follow-up should be clearly communicated to the patient Assisting women to obtain diagnostic/treatment services Securing diagnostic and/or treatment services for underinsured/uninsured women can be a challenge. It can involve the provision of follow-up care at the screening site, or a referral to an outside provider. If the service needed is a Sage covered service (see Section 3) a referral should be made to a Sage provider who can provide this service. For a current list of participating Sage Providers, see our website at: Sage Screening sites are expected to track patients with abnormal test results until they receive all their diagnostic/treatment services. Sage Screening sites should have a plan to assist women with abnormal test results receive the recommended care. Sites are expected to work with each woman to ensure that she understands the need for follow-up and knows where and how to access these services. Sites should be aware of the 12

14 resources available to women (including MinnesotaCare and MA/BC), and how to access these services. The Sage Screening Program Follow-up Coordinator and/or Case Manager may be able to assist you in identifying resources for patients. Before considering a patient as lost to follow-up, there should be a minimum of three separate attempts to contact the patient, the last attempt being through certified mail. Contact should be attempted at various times of day, and on various days of the week. Sage s Case Manager is also available to try to reach patients otherwise considered lost to follow-up. For Patients requiring treatment, remember that coverage might be available through MA-BC (see Section 4). Enrollment in Medical Assistance, MinnesotaCare, and setting up billing plans are other options for women when treatment is required. A limited number of additional resources have been identified by the Sage Screening Program, but these vary by locale. Contact your Sage Regional Coordinator for assistance Sage s role in patient tracking; Breast and cervical follow-up forms In order to assure that women with abnormal screening results receive timely and appropriate follow-up, the Sage Screening Program actively tracks the care received by women with abnormal screening results. The following findings are tracked: Breast exam suspicious for cancer; Mammogram result of Assessment Incomplete, Suspicious, or Highly Suggestive of Malignancy; Pap Smear results of ASC-H (Atypical Squamous Cells: cannot rule out High Grade), LSIL (Low Grade Squamous Intraepithelial Lesions), High Grade Squamous Intraepithelial Lesion (HSIL), Atypical Glandular (AGC), Adenocarcinoma, Squamous Cell Carcinoma, and positive High Risk HPV. Any colposcopy; and Any breast diagnostic procedure- ultrasound, fine needle aspiration or biopsy 13

15 The Sage Screening Program will generate and send to the screening site an Abnormal Follow-up Report for each woman with an abnormal test result approximately 45 days after the result or procedure date. This form should be completed by the health professional involved in the patient s care, and returned to Sage within two weeks. Instructions for completing the Abnormal Follow-up Report are found on the back of each report form. When completing the Follow-up form, be sure to document all diagnostic/treatment procedures and the date(s) of completion, as well as the status of the diagnostic work-up. If you are unable to provide the outcome information, please provide the name, address and phone number of the physician to whom this patient s care has been transferred to enable Sage to request follow-up information from that provider. Through the information provided on the Follow-up Reports, the Sage Screening Program monitors the follow-up care provided to women using guidelines developed by its Medical Advisory Committee. Providers may be contacted for additional information when questions arise, or if the care provided falls outside of the expected norm. The Sage Screening Program s expectation is that diagnostic care and treatment be provided as soon as possible. The Sage Screening Program s goals for both breast and cervical abnormalities are: Breast abnormalities: A diagnosis is reached within 60 days of an abnormal screening. Treatment is initiated within 30 days of diagnosis. Cervical abnormalities: A diagnosis is reached within 60 days of an abnormal screening. Treatment for high grade lesions and invasive cancer is initiated within 30 days of diagnosis Rescreening Sage Screening sites should remind women to return for rescreening as their recommended rescreening date approaches. To facilitate this, Sage will send screening sites monthly lists of Sage patients due for screening two months in advance of the recommended rescreening date reported to Sage. Screening sites may wish to coordinate reminders with the mammography providers, as many mammography providers routinely remind women directly. 12. Imaging services This section addresses the specific issues and paperwork related to mammography facilities, ultrasound providers, and radiology groups that provide Sage Screening Program services. Patients are enrolled in the Sage Program though a participating Sage Screening clinic: imaging service providers do not enroll patients in Sage. Prior to imaging, the patient should have a clinical breast exam through the Sage Program at one of these Sage Screening clinics (unless the imaging is short interval follow-up). Imaging service providers will know a patient has been enrolled in the Sage Screening Program when they receive a unique encounter number from the referring screening site at the time of referral. This encounter number is required to report test results and to bill the Sage Screening Program. Imaging service providers must report patient test results to the Sage Screening Program on the appropriate forms. 14

16 12.1 Imaging- Screening mammograms: The Sage Screening site notifies the mammography facility that a patient is part of Sage either by sending the facility a (green) Sage Mammogram Summary form [Appendix A2], with an encounter number or by providing the encounter number by phone when scheduling the patient s mammogram. Patients should have received a clinical breast exam at the Screening site prior to her mammogram and the mammogram should be completed within 4 months of this clinical breast exam. Instructions for completing the Sage Imaging Form can be found in Appendix B2. Screening mammograms may be of two different types and are categorized that way on the Sage Imaging form. One type is the normal annual screening mammogram that requires the normal mammographic projections. This is a category [1] on the form. The other type necessary for some women is also an annual screening mammogram, but requires extra mammographic projections. This is a category [2] on the form. Without the proper category Sage can t pay the extra amount that is deserved for a category [2] mammogram Imaging: Additional mammographic views When a patient s screening mammogram, either category [1] or [2], results are categorized as assessment incomplete additional mammographic views are often ordered. For these Second Mammograms (using diagnostic views), please fill out another green Sage Imaging form using the same encounter number as the initial screening mammogram. The category to select is [3]. Again, Sage cannot pay the increased compensation for the diagnostic views unless the proper category is selected Follow-up mammograms When a Sage screening mammogram result is an ACR category 3 (probably benign-short interval follow-up suggested) the Sage Screening Program will reimburse for short term follow-up mammograms that occur within 3 to 6 months of that original screening mammogram. If more than 12 months have elapsed since the screening, the clinical breast exam must be repeated (at a Sage Screening site). A (blue) Sage Enrollment form must be completed for each short-term follow-up imaging service/ mammogram provided, even if the patient was not seen again at the clinic. In addition, a new encounter number is needed and a new (green) Sage Imaging Summary form needs to be completed (see section 6.2) Imaging: Breast ultrasounds Sage will reimburse for breast ultrasounds when recommended by a clinician or radiologist for either immediate diagnostic work-up (for an abnormal CBE or for an abnormal or assessment incomplete screening mammogram), or short-term (3 6 month) follow-up of screening abnormality Breast ultrasound for immediate diagnostic work-up The facility performing the ultrasound will need to complete another green Sage Imaging Summary form for each patient receiving an ultrasound. The encounter number from the abnormal mammogram or CBE must be indicated on the form. 15

17 Only one ultrasound may be done per encounter number and should be billed under this encounter number Short term (3 6 Month) follow-up breast ultrasound When a short-term follow-up ultrasound is recommended to follow-up on an ultrasound finding that is probably benign, the clinic needs to submit a new Sage Enrollment form with a new encounter number. If no clinic visit occurs, the imaging provider will need to get a new encounter number from the screening clinic and indicate this encounter number on the Sage Imaging Summary form Completing the Sage Imaging Summary for a breast ultrasound. In section A of the green Sage Imaging Summary category [4] must be checked and other information for completing the Sage Imaging Form according to the instructions found in Appendix B Other imaging services (i.e. breast MRI, X-ray, etc.) When other types of imaging are ordered check with your regional coordinator to determine if Sage can cover it (clinical documentation may be required). 13. Lab services This section addresses the specific issues related to cytology laboratories and pathologists that provide Sage Screening Program services, outlines procedures for providing Sagecovered lab services, and gives instructions on completing the Pap Summary and the HPV High Risk DNA Panel forms. Specific CPT Codes that can be covered are listed on the Sage Screening Program Reimbursement Rates. (see NOTE: Lab service providers do not enroll patients in the Sage Screening Program. The patient must be enrolled through a Sage screening site prior to any service. Lab service providers will know a patient has been enrolled in the Sage Screening Program when they receive a unique Sage encounter number from the screening site with the specimen. This encounter number is also required on billing submission Pap Tests The Sage Screening site enrolls a patient in Sage and assigns an encounter number. The screening site does the exam, sends the Pap slide or specimen to the lab with the patient encounter number on a (pink) Pap Summary form (an alternative reporting format following the Bethesda terminology may be used with prior approval of Sage). The lab sends the usual Pap result to the clinic, and also sends the result to the Sage Program on the Pap Summary form (or actual report if pre-approved) Completing the Pap Summary form The Pap Summary Form [Appendix A3] should be completed by the cytotechnologist or pathologist and mailed to Sage. The instructions for filling out the Pap Summary are in Appendix B3. Please note that the Specimen Type: [1] Conventional, or [2] Liquidbased must be marked on the form or we cannot process the form or pay for the Pap test HPV High Risk DNA Panel 16

18 The Sage Screening Program reimburses for HPV DNA testing only under certain circumstances (below) and NOT as an adjunct to screening. The HPV test is done to determine the need for colposcopy. Sage will reimburse: 4. Only for the High Risk DNA Panel. 5. Only an FDA approved test can be reimbursed. 6. Only one test / person / date can be reimbursed. Sage will cover a High Risk HPV DNA Panel when done: 1. to triage an ASC-US Pap result when the Pap was covered by Sage. This can be done either reflexively from the original Pap specimen if it was a liquid-based Pap, or by a return office visit (also covered) where the HPV sample is collected (kit to collect sample is not covered). 2. for a 12 month follow-up after a colposcopy that was indicated by an ASC-H or LSIL Pap (the colposcopy result cannot have been CIN 2 or 3). 3. for a 12 month follow-up after a colposcopy that was indicated by an ASC-US Pap (the colposcopy result cannot have been CIN AND there must have been a positive HPV at the time of the colposcopy). 4. at the time of colposcopy for workup of a AGC-NOS Pap result (endocervical cells). NOTE: There is nothing to mark on the Sage Enrollment form for this situation, but a sentence should be placed in the Comments area of the form to the effect that an HPV test on an AGC-NOS Pap was \collected with this colposcopy. Also a Sage HPV High Risk DNA Panel form should be sent to Sage with the same encounter Number as the Enrollment form Either the Sage Pap Summary form (if the HPV test is done reflexively on the Pap sample) or the HPV High Risk DNA Panel form is used to report HPV findings to the Sage Screening Program and can be completed by the screening site or by the lab. Alternately, a copy of the report can be sent if the encounter number is added to the report. The following information is required on the form: Sage encounter number, patient name, date specimen collected, lab name (name of facility where HPV was read), specimen number (optional), High Risk DNA Panel interpretation result and the date reported Lab Services - Pathology The Sage Screening Program reimburses for the following services provided by pathologists: Evaluation of abnormal screening Pap smears. Surgical pathology associated with a cervical biopsy done by colposcopy. Endocervical sampling (ECS) obtained by ECC or ECB*. Evaluation of an aspirate obtained through a Fine Needle Aspiration of the breast. Pathology associated with outpatient breast biopsies as described in Section 10. Pathology associated with endometrial biopsies as described in Section 3. 17

19 * If the ECS is sent for cytology, it can only be reimbursed using the CPT codes 88150, 88164, or P3000 and at those rates. If the ECS is sent for histology, it can be billed using the higher reimbursed CPT code Billing and reimbursement This section covers billing and reimbursement from the Sage Screening Program. Provider Agreements: The Sage Screening Program can only reimburse organizations that have a current provider agreement (appendix C1) with the Sage Screening Program. Coordination between Screening Sites and Imaging and Lab Service Providers: Due to the different billing arrangements that imaging and lab providers may have with the Sage Screening Program, it is imperative that screening sites and imaging and lab providers communicate, and establish mutually agreeable billing arrangements. It is recommended that a contact person and phone number at each organization working together to provide Sage Screening Program services be identified, and that an annual or semiannual meeting is held to discuss any issues that may arise. Sage Screening Program staff is always available for assistance in establishing these links or in resolving any problems that may occur. Coordination between Billing and Clinical Staff: Patient results must be received and processed by the Sage Screening Program before payment can be made for services provided. In addition, the patient s encounter number must appear on all billing submissions. Good coordination and communication between billing and clinical staff facilitates resolving any problems that may occur to ensure the timely payment of claims Billing: Basic Requirements Sage Screening Program is considered the payer of last resort, and other sources of payment such as patient insurance should be pursued prior to billing the Sage Screening Program. The provider agrees to accept Sage Screening Program s allowable fee as full payment from all sources (including third party coverage). All Sage Screening Program covered services are free to the patient once she is enrolled in the program. The patient should never be billed for services reimbursable under the Sage Screening Program. The patient should not be charged a co-pay. Claims must be received within 1 year from date of service 14.2 Allowable procedure codes Sage Screening Program will only accept the CPT codes that are relevant to breast or cervical cancer screening and/or diagnostics. When billing for one component of mammography or ultrasound services (i.e., professional or technical), use the appropriate modifier. The provider determines the appropriate office visit level to bill. Note:Sage can only reimburse a level of office visit at a reimbursement level. 18

20 Any CPT code other than those relevant to breast or cervical cancer screening and/or diagnostics will be automatically disallowed Rates Federal law (Public Law ) restricts Sage Program reimbursement rates to the Medicare (CMS) rate for each allowable service (see Sage Screening Program rates are based on the annual CMS Physician Fee Schedule, the CMS Clinical Laboratory Fee Schedule, the Outpatient Prospective Payment System Fee Schedule, and the Ambulatory Surgical Center Fee Schedule. Rates change January 1 of each year, and providers will be notified of the changes. Rates may be updated June 30 th of each year. Note: that Sage can only reimburse a level of office visit at a reimbursement level Submitting claims Sage accepts electronic claims as an ANSI 837 file and using Electronic Data Interchange to submit the claim file. o The designated MDH Sage clearing house is Health-e-Web (HeW). o The Sage Programs Payer Identification is MNDH1. o You must provide the Sage encounter number (or M#) on the 837file as the Subscriber Identifier. o Sage will continue to accept paper claims (see below) for an indeterminate period of time; however, facilities are encouraged to change to electronic claims as soon as possible. Sage Screening Program can also accept claim submission on one of the following: 1. Sage Screening Program Reimbursement and Billing Summary 2. UB CMS-1500 The following items must be listed on these forms Federal Tax ID # of organization to be paid Name of organization to be paid Address of organization to be paid Date of Service Sage Screening Program Encounter Number Patient s Name CPT Code (including modifier, if applicable) Charge for services provided Amount Paid by Insurance (per CPT code), with explanation of benefits (EOB s) attached. Paper claims should be mailed to: Cancer Control Section Minnesota Department of Health 19

21 85 East Seventh Place P.O. Box St. Paul, MN Patients with insurance Insurance should be billed prior to billing the Sage Screening Program. The provider must supply the EOB information in the 837 file or attach a copy of the explanation of benefits (EOB) to a paper claim form submitted to the Sage Screening Program. If insurance pays more than the Sage Screening Program allowable rate, the Sage Screening Program cannot pay the difference and the patient cannot be billed for any portion remaining. Health Savings Accounts (HSAs) are an account with an IRS status for individuals who have high-deductible insurance plans. These are not considered a 3 rd party payor and should not be used to reimburse claims in advance of submission to Sage Payment Claims are processed approximately every two weeks. An electronic transmission of payment should be received shortly after the Sage payment process is completed. Your electronic transmission may contain payment from other programs processed through the State of Minnesota. The payment information can be found at: The Sage Screening Program payments will be clearly marked and contain a Sage payment number as a reference Credits In situations in which an insurance payment is received after Sage has paid your claim, or payment has been made to your organization in error, reimbursement to the Sage Screening Program can be made by Issuing a check payable to Treasurer State of Minnesota: On the stub of the check, please include the date of service, encounter number, patient s name, CPT code, and the amount you received (including the management fee). If more than one encounter number is being reimbursed, either 1) attach a list to the check or 2) highlight the items to be reimbursed on the remittance advice and attach to the check. After this information is processed by the Sage Screening Program, the check will be forwarded to MDH Financial Services for deposit. The check with documentation should be mailed to: Sage Screening Program MDH/Cancer Control Section Central Cashiering-Golden Rule Building PO Box St. Paul, MN Remittance A remittance advice detailing all claims processed is sent: 20

Sage Screening Program The Sage Screening Program is a statewide, comprehensive breast and cervical cancer control program whose primary objective is

Sage Screening Program The Sage Screening Program is a statewide, comprehensive breast and cervical cancer control program whose primary objective is DAS (Direct Appointment Scheduling) Training Manual MINNESOTA S CANCER SCRENlNG PROGRAM Within the Minnesota Department of Health s Cancer Control Section Sage Screening Program The Sage Screening Program

More information

ALGORITHM 1: PAP & HIGH-RISK HPV SCREENING GUIDELINES

ALGORITHM 1: PAP & HIGH-RISK HPV SCREENING GUIDELINES ALGORITHM 1: PAP & HIGH-RISK HPV SCREENING GUIDELINES Women under 30 years not recommended Women 30 years and older Women 30 years and older x3 consecutive screens Women 30 years and older positive and

More information

ALABAMA BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM PROVIDER MANUAL

ALABAMA BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM PROVIDER MANUAL ALABAMA BREAST AND CERVICAL CANCER EARLY DETECTION PROGRAM PROVIDER MANUAL Revised January 2012 1 TABLE OF CONTENTS PROGRAM OVERVIEW.. 3 INTRODUCTION 5 SCREENING ELIGIBILITY GUIDELINES 6 PATIENT RIGHTS..

More information

Provider Reimbursement for Women's Cancer Screening Program

Provider Reimbursement for Women's Cancer Screening Program Reimbursement Schedule July 1, 2015 June 30, 2016 Office Visits - Established Patients Office Visit / Minimal / no physician 99211 $ 16.70 Office Visit / Problem focused History / exam 99212 $ 36.46 Preventive

More information

Allowable CPT Codes for the Illinois Breast and Cervical Cancer Program FOR INTERNAL USE ONLY Effective February 1, 2013

Allowable CPT Codes for the Illinois Breast and Cervical Cancer Program FOR INTERNAL USE ONLY Effective February 1, 2013 Allowable CPT s for the Illinois Breast and Cervical Cancer Program OR INTERNAL USE ONLY Effective ebruary 1, 2013 Screening services should include CBE, pelvic exam, mammogram and Pap test. Every screening

More information

Office Visits. Breast

Office Visits. Breast Early Detection Works Reimbursement Fee Schedule Effective for services on or after July 1, 2015 Program guidelines require that be the payor of last resort. Program funds cannot be used to supplement

More information

An Overview Cervical Cancer Screening and Cervical Intraepithelial Neoplasia (CIN)

An Overview Cervical Cancer Screening and Cervical Intraepithelial Neoplasia (CIN) An Overview Cervical Cancer Screening and Cervical Intraepithelial Neoplasia (CIN) Linda Kelly, DNP, ANP-BC Obstetrics and Gynecology Massachusetts General Hospital Sonja and Deborah Kelly Scholar February

More information

Explanation of your PAP smear

Explanation of your PAP smear Explanation of your PAP smear Approximately 5-10% of PAP smears in the United States are judged to be abnormal. Too often, the woman who receives this news worries that she already has, or will develop,

More information

National Survey of Primary Care Physicians Cancer Screening Recommendations and Practices. Breast and Cervical Cancer Screening Questionnaire

National Survey of Primary Care Physicians Cancer Screening Recommendations and Practices. Breast and Cervical Cancer Screening Questionnaire Form Approval OMB No. 0925-0562 Expires 07/31/2009 National Survey of Primary Care Physicians Cancer Screening Recommendations and Practices Breast and Cervical Cancer Screening Questionnaire Conducted

More information

Management of Abnormal PAP Smears. K Chacko, MD, FACP 2010 GIM Conference

Management of Abnormal PAP Smears. K Chacko, MD, FACP 2010 GIM Conference Management of Abnormal PAP Smears K Chacko, MD, FACP 2010 GIM Conference Scope of the Problem About 7-10% 7 of PAPs will come back abnormal 3.5 to 4 million in the US each year Approximate 4000 deaths

More information

FY 2016 BCCCNP Procedure Code Reference Chart

FY 2016 BCCCNP Procedure Code Reference Chart 77057 G0202 77063 77055 G0206 77056 G0204 G0279 FY 2016 Procedure Reference Chart Screening mammography, bilateral (two view film study of each breast) Screening mammography producing direct digital image,

More information

FRIEND TO FRIEND CPT CODES 2015 2016. Diagnostic digital breast tomosynthesis, unilateral (list separately in addition to code for primary procedure)

FRIEND TO FRIEND CPT CODES 2015 2016. Diagnostic digital breast tomosynthesis, unilateral (list separately in addition to code for primary procedure) FRIEND TO FRIEND CPT CODES 2015 2016 CPT CODE SERVICE DESCRIPTION FEE EFFECTIVE G0101 Screening pelvic examination $36.69 01 Jan 16 G0202 Mammography, screening, digital, bilateral (2 view film study of

More information

Every Woman Counts. Step-by-Step Provider User Guide

Every Woman Counts. Step-by-Step Provider User Guide Every Woman Counts Step-by-Step Provider User Guide California Department of Health Care Services Cancer Detection and Treatment Branch and Xerox State Healthcare, LLC PROPubs 6/14 TABLE OF CONTENTS INTRODUCTION...

More information

Cervical Cancer Screening and Management Guidelines: Changing Again, Huh?

Cervical Cancer Screening and Management Guidelines: Changing Again, Huh? Cervical Cancer Screening and Management Guidelines: Changing Again, Huh? Summary of 2013 recommendations from ASC (American Cancer Society), ASCCP (American Society for Colposcopy and Cervical Pathology),

More information

FY 2016 BCCCNP Unit Cost Reimbursement Rate Schedule

FY 2016 BCCCNP Unit Cost Reimbursement Rate Schedule Unit Cost Reimbursement Schedule 1 Screening Mammogram (Bilateral) Service CPT Code FY16 2 Digital Screening Mammogram (Bilateral) 3 Diagnostic Mammogram (Unilateral) 4 Digital Diagnostic Mammogram (Unilateral)

More information

Pap smears, cytology and CCHC lab work and follow up

Pap smears, cytology and CCHC lab work and follow up Pap smears, cytology and CCHC lab work and follow up What is a Pap Smear? A Pap smear (also known as the Pap test) is a medical procedure in which a sample of cells from a woman's cervix (the end of the

More information

Cervical Cancer The Importance of Cervical Screening and Vaccination

Cervical Cancer The Importance of Cervical Screening and Vaccination Cervical Cancer The Importance of Cervical Screening and Vaccination Cancer Cells Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body. Sometimes, this

More information

NATIONAL GUIDELINE FOR CERVICAL CANCER SCREENING PROGRAMME

NATIONAL GUIDELINE FOR CERVICAL CANCER SCREENING PROGRAMME NATIONAL GUIDELINE FOR CERVICAL CANCER SCREENING PROGRAMME CERVICAL CANCER Introduction Cancer of the cervix is the second most common form of cancer amongst South African women. Approximately one in every

More information

TITLE 317. OKLAHOMA HEALTH CARE AUTHORITY CHAPTER 35. MEDICAL ASSISTANCE FOR ADULTS AND CHILDREN-ELIGIBILITY SUBCHAPTER 21

TITLE 317. OKLAHOMA HEALTH CARE AUTHORITY CHAPTER 35. MEDICAL ASSISTANCE FOR ADULTS AND CHILDREN-ELIGIBILITY SUBCHAPTER 21 TITLE 317. OKLAHOMA HEALTH CARE AUTHORITY CHAPTER 35. MEDICAL ASSISTANCE FOR ADULTS AND CHILDREN-ELIGIBILITY SUBCHAPTER 21. OKLAHOMA CARES BREAST AND CERVICAL CANCER TREATMENT PROGRAM 317:35-21-1. Oklahoma

More information

The Pap test: Evidence to date. Original source: Alliance for Cervical Cancer Prevention (ACCP)

The Pap test: Evidence to date. Original source: Alliance for Cervical Cancer Prevention (ACCP) The Pap test: Evidence to date Original source: Alliance for Cervical Cancer Prevention (ACCP) www.alliance-cxca.org Overview: Description of the Papanicolaou (Pap) smear test and how it works Infrastructure

More information

Breast and Cervical Cancer Treatment Program (BCCTP) Application Guide

Breast and Cervical Cancer Treatment Program (BCCTP) Application Guide Breast and Cervical Cancer Treatment Program (BCCTP) Application Guide 2012 Created January 1, 2012 BCCTP APPLICATION GUIDE Table of Contents Page Application Process 3 Application Checklist 4 Federal

More information

The society for lower genital tract disorders since 1964.

The society for lower genital tract disorders since 1964. The society for lower genital tract disorders since 1964. Updated Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors American Society for and Cervical Pathology

More information

Management of Abnormal Pap Smear Clinical Practice Guideline

Management of Abnormal Pap Smear Clinical Practice Guideline Management of Abnormal Pap Smear Clinical Guideline General Principles: The Papanicolaou (Pap) smear is widely credited with reducing mortality from cervical cancer, and remains the single best method

More information

Nicole Kounalakis, MD

Nicole Kounalakis, MD Breast Disease: Diagnosis and Management Nicole Kounalakis, MD Assistant Professor of Surgery Goal of Breast Evaluation The goal of breast evaluation is to classify findings as: normal physiologic variations

More information

Item 1: Tracks all laboratory tests ordered or done within the practice, until results are available to the clinician, flagging overdue results.

Item 1: Tracks all laboratory tests ordered or done within the practice, until results are available to the clinician, flagging overdue results. PPC 6: TEST TRACKING Element A: Test Tracking and Follow-Up Item 1: Tracks all laboratory tests ordered or done within the practice, until results are available to the clinician, flagging overdue results.

More information

Appendix 1: Glossary

Appendix 1: Glossary Glossary Abnormal smear Adenocarcinoma Adequate smear Abnormal smear refers to all smears showing epithelial cell abnormalities, including atypical squamous cells of undetermined significance (ASCUS),

More information

OBJECTIVES By the end of this segment, the community participant will be able to:

OBJECTIVES By the end of this segment, the community participant will be able to: Cancer 101: Cancer Diagnosis and Staging Linda U. Krebs, RN, PhD, AOCN, FAAN OCEAN Native Navigators and the Cancer Continuum (NNACC) (NCMHD R24MD002811) Cancer 101: Diagnosis & Staging (Watanabe-Galloway

More information

Pre test Question 2. Emily D. Babcock, DHSc, PA C, DFAAPA CAPA Annual Conference Palm Springs, California October 4, 2013

Pre test Question 2. Emily D. Babcock, DHSc, PA C, DFAAPA CAPA Annual Conference Palm Springs, California October 4, 2013 Emily D. Babcock, DHSc, PA C, DFAAPA CAPA Annual Conference Palm Springs, California October 4, 2013 Objectives After completion of this presentation, the participant will be able to: Explain the current

More information

NWT Clinical Practice Information Notice

NWT Clinical Practice Information Notice NWT Clinical Practice Information Notice Upon receipt, please file this notice in Section C, Clinical Practice Information Binder for future reference. The following Clinical Practice has been approved

More information

Request for Applications

Request for Applications Request for Applications Breast and Cervical Cancer Control Program Screening Services, NC WISEWOMAN Cardiovascular Disease Screening Services FUNDING AGENCY: North Carolina Department of Health and Human

More information

Cancer of the Cervix

Cancer of the Cervix Cancer of the Cervix WOMENCARE A Healthy Woman is a Powerful Woman (407) 898-1500 A woman's cervix (the opening of the uterus) is lined with cells. Cancer of the cervix occurs when those cells change,

More information

Examples of good screening tests include: mammography for breast cancer screening and Pap smears for cervical cancer screening.

Examples of good screening tests include: mammography for breast cancer screening and Pap smears for cervical cancer screening. CANCER SCREENING Dr. Tracy Sexton (updated July 2010) What is screening? Screening is the identification of asymptomatic disease or risk factors by history taking, physical examination, laboratory tests

More information

ALLINA HEALTH LABORATORY

ALLINA HEALTH LABORATORY Cytology DIRECTOR: TECHNICAL SPECIALIST: JACK SHELTON, MD SCOTT HORSFALL, CT (ASCP) Requisitions A properly completed requisition form must accompany each Cytology specimen submitted to Allina Health Laboratory.

More information

Cervical Cancer Screening. Clinical Practice Guidelines for Average Risk Women

Cervical Cancer Screening. Clinical Practice Guidelines for Average Risk Women QEYGYN051 Cervical Cancer Screening Clinical Practice Guidelines for Average Risk Women For Approval of the Provincial Medical Affairs Committee October 2013 Table of Contents Page Background Information

More information

American Academy of Family Physicians

American Academy of Family Physicians American Academy of Family Physicians Barbara E. Stanford MD Grand Rapids Family Medicine Residency Wege Family Medicine HPV is transient in most women HPV-75% Normal ASCUS LSIL HSIL Cancer 80-90% 75%???

More information

Sam & Jennie Bennett Breast Care Center

Sam & Jennie Bennett Breast Care Center Sam & Jennie Bennett Breast Care Center Sam & Jennie Bennett Breast Care Center d Central Maine Medical Center s Sam & Jennie Bennett Breast Care Center is a private place where a woman can find comprehensive

More information

THE MAIN ADVANTAGES OF THE HPV TEST DO HPV TESTS ATTRACT A MEDICARE

THE MAIN ADVANTAGES OF THE HPV TEST DO HPV TESTS ATTRACT A MEDICARE Understanding HPV For many years, Pap smears have been the most effective way to tell if a woman is at risk of developing cervical cancer. The Pap smear may also identify a common viral infection called

More information

Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64

Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64 Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64 1. BMI - Documented in patients medical record on an annual basis. Screen for obesity and offer intensive counseling and behavioral

More information

Making Sense of Your Pap and HPV Test Results

Making Sense of Your Pap and HPV Test Results Making Sense of Your Pap and HPV Test Results Keep this booklet until you get your test results back from your doctor. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention

More information

American Society of Cytopathology Core Curriculum in Molecular Biology

American Society of Cytopathology Core Curriculum in Molecular Biology American Society of Cytopathology Core Curriculum in Molecular Biology American Society of Cytopathology Core Curriculum in Molecular Biology Chapter 5 Applications of Molecular Testing Hybrid Capture

More information

Breast Imaging Made Brief and Simple. Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA

Breast Imaging Made Brief and Simple. Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA Breast Imaging Made Brief and Simple Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA What women are referred for breast imaging? Two groups of women are referred for

More information

D. FREQUENTLY ASKED QUESTIONS

D. FREQUENTLY ASKED QUESTIONS ACR BI-RADS ATLAS D. FREQUENTLY ASKED QUESTIONS 1. Under MQSA, is it necessary to include a numeric assessment code (i.e., 0, 1, 2, 3, 4, 5, or 6) in addition to the assessment category in all mammography

More information

PROPERTY OF ELSEVIER SAMPLE CONTENT - NOT FINAL ABNORMAL PAP SMEAR (ABNORMAL CERVICAL CYTOLOGIC FINDINGS) Kathleen Dor

PROPERTY OF ELSEVIER SAMPLE CONTENT - NOT FINAL ABNORMAL PAP SMEAR (ABNORMAL CERVICAL CYTOLOGIC FINDINGS) Kathleen Dor 1 ABNORMAL PAP SMEAR (ABNORMAL CERVICAL CYTOLOGIC FINDINGS) Kathleen Dor Cervical cytology screening has significantly decreased rates of mortality from cervical cancer; however, 400 women die each year

More information

Solving the Cytology Coding Puzzle. Carol A. Filomena, MD Director of Pathology Duke Raleigh Hospital

Solving the Cytology Coding Puzzle. Carol A. Filomena, MD Director of Pathology Duke Raleigh Hospital Solving the Cytology Coding Puzzle Carol A. Filomena, MD Director of Pathology Duke Raleigh Hospital Conference Objectives Learn how to appropriately code cervical/vaginal (Pap) Tests and associated ancillary

More information

GUIDELINE DOCUMENT CERVICAL CANCER SCREENING IN SOUTH AFRICA 2015

GUIDELINE DOCUMENT CERVICAL CANCER SCREENING IN SOUTH AFRICA 2015 GUIDELINE DOCUMENT CERVICAL CANCER SCREENING IN SOUTH AFRICA 2015 Cervical cancer remains an important cause of morbidity and mortality in South Africa. At present the national cervical cancer prevention

More information

BREAST MASS Lisa Schmidt, M.P.H., and Eve A. Kerr, M.D.

BREAST MASS Lisa Schmidt, M.P.H., and Eve A. Kerr, M.D. - 71-5. BREAST MASS Lisa Schmidt, M.P.H., and Eve A. Kerr, M.D. The general approach to breast mass work-ups was obtained from opinions of the Committee of Gynecologic Practice of the American College

More information

Pap Smears Where are we headed. Ian H. Thorneycrroft PhD,MD,FACOG

Pap Smears Where are we headed. Ian H. Thorneycrroft PhD,MD,FACOG Pap Smears Where are we headed Ian H. Thorneycrroft PhD,MD,FACOG Where are we headed/ Less frequent sampling. More use of DNA technology.?increase in cervical cancer. History The test was invented by and

More information

Women with Medicare. Visiting Your Doctor for a Pap Test, Pelvic Exam, and Clinical Breast Exam

Women with Medicare. Visiting Your Doctor for a Pap Test, Pelvic Exam, and Clinical Breast Exam CENTERS FOR MEDICARE & MEDICAID SERVICES Women with Medicare Visiting Your Doctor for a Pap Test, Pelvic Exam, and Clinical Breast Exam This official government booklet will help you understand what s

More information

Harlem Hospital Center Integrated Radiology Residency Program Mammography Educational goals and objectives

Harlem Hospital Center Integrated Radiology Residency Program Mammography Educational goals and objectives Harlem Hospital Center Integrated Radiology Residency Program Mammography Educational goals and objectives Rotation 1 (Radiology year 1/2) Knowledge Based Objectives: At the end of the rotation, the resident

More information

The BreastCare Program

The BreastCare Program The BreastCare Program BreastCare Is a Program of the Arkansas Department of Health (ADH) that Offers: Screening and diagnostic services to qualifying women at no cost Public and professional education

More information

Cervical Cancer Screening Guideline

Cervical Cancer Screening Guideline Cervical Cancer Screening Guideline Prevention 2 Abbreviations Used 2 Specimen Collection Techniques 3 Screening 4 Management Women 21 Years and Older Pap results 5 findings: ASC-US and LSIL 6 findings:

More information

Cervical Cancer Screening in HIV

Cervical Cancer Screening in HIV NORTHWEST AIDS EDUCATION AND TRAINING CENTER Cervical Cancer Screening in HIV Hillary Liss, MD Harborview Medical Center, Madison and Adult Medicine Clinics NW AETC, Medical Program Director Presentation

More information

Benefits Collaborative Policy Statement WOMEN S HEALTH SERVICES

Benefits Collaborative Policy Statement WOMEN S HEALTH SERVICES Page 1 uf 5 The services listed below are not inclusive of all services available to women on Medicaid, but WOMEN S HEALTH SERVICES Benefits Collaborative Policy Statement Women s health services are preventative

More information

Building Bridges Program Health Insurance Programs for Women with and at risk of Cancer

Building Bridges Program Health Insurance Programs for Women with and at risk of Cancer Health Insurance Programs for Women with and at risk of Cancer Tarrant County Indigent Health Care (CIHCP) provides health care services to eligible residents through the counties, hospital districts and

More information

Breast Disease: Diagnosis and Management

Breast Disease: Diagnosis and Management Breast Disease: Diagnosis and Management Nicole Kounalakis, MD Assistant Professor of Surgery Christina A. Finlayson, MD Professor of Surgery Director, Dianne O Connor Thompson Breast Center Goal of Breast

More information

Colposcopy Mentorship Program FAQs

Colposcopy Mentorship Program FAQs Colposcopy Mentorship Program FAQs What is the Colposcopy Mentorship Program? The ASCCP Colposcopy Mentorship Program (CMP) is a three-tiered educational program designed to improve the beginning colposcopist

More information

MEDICARE ADVANTAGE PRIVATE FEE FOR SERVICE (PFFS) PLAN 2009 TERMS AND CONDITIONS OF PAYMENT. Table of Contents

MEDICARE ADVANTAGE PRIVATE FEE FOR SERVICE (PFFS) PLAN 2009 TERMS AND CONDITIONS OF PAYMENT. Table of Contents MEDICARE ADVANTAGE PRIVATE FEE FOR SERVICE (PFFS) PLAN 2009 TERMS AND CONDITIONS OF PAYMENT 1. Introduction Table of Contents 2. When a provider is deemed to accept Blue Cross of Idaho Flexi Blue PFFS

More information

Thank you for choosing Tampa Bay Breast Care Specialists.

Thank you for choosing Tampa Bay Breast Care Specialists. , LLC Thank you for choosing Tampa Bay Breast Care Specialists. Appointment Location: Life Hope Medical Office Building St. Joseph s Hospital - North Pre-Appointment Instructions Please bring the following

More information

Cancer 101. Cancer Screening & Early Detection. Lesson 2

Cancer 101. Cancer Screening & Early Detection. Lesson 2 Cancer 101 Cancer Screening & Early Detection Lesson 2 1 We will learn to explain to family and friends: The importance of early detection Screening methods used in the detection of cancer Symptoms of

More information

Patient Resource Guide for Billing and Insurance Information

Patient Resource Guide for Billing and Insurance Information Patient Resource Guide for Billing and Insurance Information 17 Patient Account Payment Policies July 2012 Update Lexington Clinic Central Business Office Payment Policies Customer service...2 Check-in...2

More information

Benign Breast Diseases

Benign Breast Diseases Benign Breast Diseases Most women have changes in their breasts during their lifetime. Many of these changes are caused by hormones. For example, your breasts may feel more lumpy or tender at different

More information

Breast Cancer Screening Guideline July 1, 2010

Breast Cancer Screening Guideline July 1, 2010 Breast Cancer Screening Guideline July 1, 2010 Introduction These guidelines are informational only and are not intended or designed to substitute the reasonable exercise of independent clinical judgment

More information

Visiting Your Doctor for a Pap Test, Pelvic Exam, and Clinical Breast Exam

Visiting Your Doctor for a Pap Test, Pelvic Exam, and Clinical Breast Exam WOMEN with MEDICARE Visiting Your Doctor for a Pap Test, Pelvic Exam, and Clinical Breast Exam This booklet will help you understand: What is covered in the Original Medicare Plan. What Medicare pays.

More information

BREAST IMAGING H. Lee Moffitt Cancer Center and Research Institute

BREAST IMAGING H. Lee Moffitt Cancer Center and Research Institute BREAST IMAGING H. Lee Moffitt Cancer Center and Research Institute Rotation Director: Margaret Szabunio, M.D. General Goals: On this rotation, the resident will learn to interpret screening mammograms

More information

PAP SMEARS: DO OLDER WOMEN REALLY NEED THEM?

PAP SMEARS: DO OLDER WOMEN REALLY NEED THEM? PAP SMEARS: DO OLDER WOMEN REALLY NEED THEM? Cervical cancer - a concern for midlife and older women Cervical cancer can be prevented in the vast majority of women. Yet it remains the 9 th leading cause

More information

Willow Bend OB/GYN Obstetrics, Gynecology & Infertility

Willow Bend OB/GYN Obstetrics, Gynecology & Infertility Dear Patient, Welcome to our medical office. We look forward to meeting you soon. In order to provide you with the best possible care, please complete our registration forms prior to your first visit and

More information

Preventive Care Guideline for Asymptomatic Elderly Patients Age 65 and Over

Preventive Care Guideline for Asymptomatic Elderly Patients Age 65 and Over Preventive Care Guideline for Asymptomatic Elderly Patients Age 65 and Over 1. BMI - Documented in patients medical record on an annual basis up to age 74. Screen for obesity and offer counseling to encourage

More information

Medicare Part B. Mammograms - Updated Billing Guide for Screening and Diagnostic Tests

Medicare Part B. Mammograms - Updated Billing Guide for Screening and Diagnostic Tests Mammograms - Updated Billing Guide for Screening and Diagnostic Tests This article from Medicare B News Issue 223 dated October 21, 2005 is being updated and reprinted to ensure that the Noridian Administrative

More information

3/3/2014 NEW ERA OF THE CERVICAL PAP SMEAR TESTING. Objectives

3/3/2014 NEW ERA OF THE CERVICAL PAP SMEAR TESTING. Objectives Yasmin Elshenawy, M.D Outpatient Cytopathology Center Johnson city, TN NEW ERA OF THE CERVICAL PAP SMEAR TESTING Disclosure Statement of Financial Interest I am Yasmin Elshenawy, MD DO NOT have a financial

More information

What is HPV and why is it so important?

What is HPV and why is it so important? Understanding HPV For many years, Pap smears have been the most effective way to tell if a woman is at risk of developing cervical cancer. The Pap smear may also identify a common viral infection called

More information

Patient Account Services. Patient Reference & Frequently Asked Questions. Admissions

Patient Account Services. Patient Reference & Frequently Asked Questions. Admissions Patient Account Services Patient Reference & Frequently Asked Questions Admissions Each time you present for a new medical service, a new account number will be assigned. You will be asked to pay any patient

More information

The Cervical Screening Manual

The Cervical Screening Manual The Cervical Screening Manual A Guide for Health Departments and Providers Collaboration Partners: Chronic Disease and Injury Section Breast and Cervical Cancer Control Program Women s and Children s Health

More information

Abnormal Pap Smear Tracking in General Internal Medicine Clinic

Abnormal Pap Smear Tracking in General Internal Medicine Clinic Abnormal Pap Smear Tracking in General Internal Medicine Clinic J A C O B K U R L A N D E R & T A R A O B R I E N C A R Q I P R O J E C T J A N U A R Y 2 0, 2 0 1 0 PDSA cycle Plan Act Do Study Our Charge

More information

Benign Breast Disorders

Benign Breast Disorders Benign Breast Disorders Valerie Swiatkowski, MD Medical Student Lecture Introduction 16% of women ages 40-69 will seek advice from their physician regarding breast complaints over 10 years. Failure to

More information

Cervical cancer screening with the HPV test and the Pap test in women ages 30 and older

Cervical cancer screening with the HPV test and the Pap test in women ages 30 and older Cervical cancer screening with the HPV test and the Pap test in women ages 30 and older When to get tested and how to make sense of your test results If you are 30 years or older and your Pap test is normal

More information

Understanding. Cervical Changes A Health Guide for Women. National Cancer Institute U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Understanding. Cervical Changes A Health Guide for Women. National Cancer Institute U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Cancer Institute Understanding Cervical Changes A Health Guide for Women U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health This guide helped me talk with my doctor after

More information

How Likely Clinically Suspicious Looking Cervix is Cervical Cancer?

How Likely Clinically Suspicious Looking Cervix is Cervical Cancer? World Journal of Research and Review (WJRR) ISSN:2455-3956, Volume-3, Issue-2, August 2016 Pages 18-19 How Likely Clinically Suspicious Looking Cervix is Cervical Cancer? Ying Yiing Lou, Sahathevan Sathiyathasan

More information

The Greater Atlanta Affiliate 2004-2005 Grant Recipients

The Greater Atlanta Affiliate 2004-2005 Grant Recipients The Greater Atlanta Affiliate 2004-2005 Grant Recipients Atlanta Lesbian Cancer Initiative Treatment, Education, Support & Screening: This award supports psychosocial, informational, and physical support

More information

Information for patients attending Breast Imaging

Information for patients attending Breast Imaging James Paget University Hospitals NHS Foundation Trust Information for patients attending Breast Imaging Patient Information Department Folder Telephone: 01493 452885 Contents Introduction 4 Screening

More information

Cervical Screening Programme, England. Statistics for

Cervical Screening Programme, England. Statistics for Cervical Screening Programme, England Statistics for 2014-15 Published 10 November 2015 We are the trusted national provider of high-quality information, data and IT systems for health and social care.

More information

Cervical Screening. Understanding cervical smear test results. Taku hauora, taku tinana, taku tumanako My health, my body, my future

Cervical Screening. Understanding cervical smear test results. Taku hauora, taku tinana, taku tumanako My health, my body, my future Cervical Screening Understanding cervical smear test results Taku hauora, taku tinana, taku tumanako My health, my body, my future Cervical smear test results A cervical smear test shows if there are abnormal

More information

Information provided in these web pages was last updated on November 2, 2009 BREAST CANCER

Information provided in these web pages was last updated on November 2, 2009 BREAST CANCER BREAST CANCER BACKGROUND Facts about breast cancer Breast cancer affects both men and women, though it occurs rarely in men. Breast cancer is the most common form of cancer in women with the exception

More information

Cervical Cancer: Prevention and Early Detection What is cervical cancer?

Cervical Cancer: Prevention and Early Detection What is cervical cancer? Cervical Cancer: Prevention and Early Detection What is cervical cancer? Cervical cancer is cancer that starts in the cervix. The cervix is the lower part of the uterus (womb). It is sometimes called the

More information

Understanding breast changes

Understanding breast changes Understanding breast changes UHN For women Read this resource to learn: Parts of your breast Types of breast changes What follow up appointments you may need Breast Imaging Department Princess Margaret

More information

Ductal carcinoma in situ (DCIS)

Ductal carcinoma in situ (DCIS) DIAGNOSIS: DCIS Ductal carcinoma in situ (DCIS) This factsheet gives information on an early form of breast cancer called ductal carcinoma in situ (DCIS). It explains what it is, how your breast is made

More information

NYSDOH. Cancer Services Program Operations Manual

NYSDOH. Cancer Services Program Operations Manual NYSDOH Cancer Services Program Operations Manual BLANK FOR PRINTING Table of Contents Chapter 1: Program Overview... - 0 - Chapter 1: CSP Program Overview... - 1 - A. NYSDOH CSP Definitions... - 1 - B.

More information

National Cervical Screening Programme Policies and Standards. Section 6: Providing a Colposcopy Service

National Cervical Screening Programme Policies and Standards. Section 6: Providing a Colposcopy Service National Cervical Screening Programme Policies and Standards Section 6: Providing a Colposcopy Service Citation: Ministry of Health. 2013. National Cervical Screening Programme Policies and Standards:

More information

Cervical Screening Programme

Cervical Screening Programme Cervical Screening Programme England 2010-11 1 The NHS Information Centre is England s central, authoritative source of health and social care information. Acting as a hub for high quality, national, comparative

More information

Participate in Cancer Screening

Participate in Cancer Screening Key #3 Participate in Cancer Screening What is Cancer? The National Cancer Institute defines cancer as A term for diseases in which abnormal cells divide without control and can invade nearby tissues.

More information

Screening for Cancer in Light of New Guidelines and Controversies. Christopher Celio, MD St. Jude Heritage Medical Group

Screening for Cancer in Light of New Guidelines and Controversies. Christopher Celio, MD St. Jude Heritage Medical Group Screening for Cancer in Light of New Guidelines and Controversies Christopher Celio, MD St. Jude Heritage Medical Group Screening Tests The 2 major objectives of a good screening program are: (1) detection

More information

Pap Tests, HPV Screening, and the HPV Vaccine

Pap Tests, HPV Screening, and the HPV Vaccine Pap Tests, HPV Screening, and the HPV Vaccine George F. Sawaya, MD Associate Professor Department of Obstetrics, Gynecology and Reproductive Sciences Department of Epidemiology and Biostatistics University

More information

Patient name; Patient address; Patient Social Security number/medical Record number; Patient date of birth; Patient phone number; Diagnosis code(s);

Patient name; Patient address; Patient Social Security number/medical Record number; Patient date of birth; Patient phone number; Diagnosis code(s); 7 Billing The Sentara Reference Laboratory billing office is open Monday through Friday from 8:00 a.m. until 4:30 p.m. and can be reached by calling (757) 388-1985. Billing Representatives will be available

More information

Clinical Indicator Ages 19-29 Ages 30-39 Ages 40-49 Ages 50-64 Ages 65+ Frequency of visit as recommended by PCP

Clinical Indicator Ages 19-29 Ages 30-39 Ages 40-49 Ages 50-64 Ages 65+ Frequency of visit as recommended by PCP SCREENING EXAMINATION & COUNSELING UPMC Health Plan Clinical Indicator Ages 19-29 Ages 30-39 Ages 40-49 Ages 50-64 Ages 65+ Annually Physical Exam and Counseling 1 Blood Pressure 2 At each visit. At least

More information

South East Scotland Breast Screening Centre

South East Scotland Breast Screening Centre South East Scotland Breast Screening Centre Ardmillan House 42 Ardmillan Terrace Edinburgh EH11 2JL Telephone: 0131 537 7410 Or to change appointments 0131 537 7400 Where are we? The screening centre is

More information

CLIENT SERVICES. Calling the Laboratory. Courier Pickups

CLIENT SERVICES. Calling the Laboratory. Courier Pickups CLIENT SERVICES Calling the Laboratory Courier Pickups Customer Support Collection Supplies Supply Request Form Requisitions and Billing Information Requirements Reports Reflex Testing Critical and Vital

More information

I screen. You screen. We all screen

I screen. You screen. We all screen I screen. You screen. We all screen for breast health! Breast Cancer Resource Center FREE Screening Mammogram Program serving Santa Barbara County It s a treat to serve you. The Breast Cancer Resource

More information

Breast care clinics. The Breast Clinics take place every week on Wednesdays. yeovilhospital.nhs.uk

Breast care clinics. The Breast Clinics take place every week on Wednesdays. yeovilhospital.nhs.uk Breast care clinics The Breast Clinics take place every week on Wednesdays 01935 384 352 yeovilhospital.nhs.uk Yeovil District Hospital NHS Foundation Trust has a specialist Breast Care Team. This team

More information

Cervical Cancer Prevention and Early Detection What is cervical cancer?

Cervical Cancer Prevention and Early Detection What is cervical cancer? Cervical Cancer Prevention and Early Detection What is cervical cancer? Cervical cancer starts in cells lining the cervix. The cervix is the lower part of the uterus (womb). It is sometimes called the

More information

Understanding Insurance and Our Billing Process

Understanding Insurance and Our Billing Process Understanding Insurance and Our Billing Process Thank you for choosing Cleveland Clinic for your healthcare needs. We appreciate the confidence you have placed in us. The purpose of this brochure is to

More information

Updated as of 05/15/13-1 -

Updated as of 05/15/13-1 - Updated as of 05/15/13-1 - GENERAL OFFICE POLICIES Thank you for choosing the Quiroz Adult Medicine Clinic, PA (QAMC) as your health care provider. The following general office policies are provided to

More information