EXPLANATION OF CHARGES 

 

A physician referred your testing to PCG Molecular. When specimens are received, PCG Molecular prepares the specimen for review and a pathologist or other trained professional interprets the test results. PCG Molecular then bills for these diagnostic services. In some cases, hospitals will refer a specimen for specialized consultation or staining procedures.

 

Women’s Health

 

PCG Molecular  performs screening and interpretation of gynecological testing (Pap smears). When requested by your physician, PCG Molecular can also use your Pap specimen to test for the presence of HPV, Chlamydia or Gonorrhea and other STI diseases.

When reviewing your Pap smear, if the preliminary results suggest a potentially abnormal reading, a pathologist will review the results. In this case, PCG Molecular will also bill a separate charge for a pathologist’s interpretation.

 

Hospital Charges

 

PCG Molecular bills for the pathologist’s services when a patient is seen at certain area hospitals. There are generally two types of pathology services: anatomic and clinical.

 

Anatomic charges are for services where a pathologist directly interpreted the result from a specimen (typically tissue). Most specimens are submitted to the hospital lab from a surgical procedure performed at the hospital.

 

Clinical charges typically represent blood or urine specimens that are placed into machines for automatic processing. Charges for clinical pathology services are generally covered by the patient’s insurance policy as a reasonable and necessary medical service. Both the Federal Clinical Laboratory Improvement Amendments (CLIA) of 1998 and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) both require certain professional pathology services be provided in a hospital’s clinical laboratory to assure quality care for all patients. Medically reliable laboratory results are essential to the diagnosis and treatment of individual patients and require the oversight of a pathologist.

 

The pathologist is medically responsible for the testing performed in the hospital’s clinical laboratory and provides professional services in the following ways:

  1. Ensuring quality in all aspects of testing including collection of specimens and reporting of results.

  2. Selecting, evaluating and validating test methods.

  3. Advising laboratory technical personnel.

  4. Ensuring that the physical plant and environment in the laboratory are appropriate for the testing performed.

  5. Ensuring that procedures are adequate to determine the accuracy, precision, and other pertinent performance characteristics of the test used.

  6. Ensuring that there is appropriate proficiency testing to validate laboratory procedures.

  7. Ensuring that appropriate corrective action is taken when results or controls are unsatisfactory.

  8. Ensuring that appropriate quality control and quality assurance programs are established and maintained.

  9. Ensuring that consultation is available to healthcare professionals relating to test interpretation.

  10. Advising the hospital concerning the number of employees and qualification of employees necessary for the proper performance of laboratory tests.

  11. Ensuring that all personnel have appropriate education, experience and continuing education to maintain a high level of quality.

  12. Ensuring that an approved procedure manual is available to personnel responsible for all aspects of testing and processing.

  13. Working with various departments and services to identify and provide testing appropriate to their needs.

  14. Assuring that the hospital laboratory is in compliance with state licensure laws, Medicare requirements, requirements of the Clinical Laboratory Amendments of 1998 and the Joint Commission on Accreditation of Healthcare Organization Program Standards.

In the State of Georgia, the pathologists that are not employed by the hospital must separately bill patients or their insurers for these professional services.

Most insurance carriers in Georgia recognize these professional activities as covered services. If, however, an insurance carrier does not cover these charges, the pathologist bills the patient for these medically necessary services.

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