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结算和财务援助

概述

博188金宝基础医学致力于帮助患者访问我们的测试服务。通过我们的FoundationAccess™支持计划,我们为每个测试的测试完成了一个福利调查,并与我们预期的任何患者联系到可能会出现口袋费用。根据具体测试,患者可能已经通过Medicare或私人保险覆盖。我们还提供基于需求的符合条件患者的财务援助计划。

一些商业健康计划,如Cigna和许多BlueShield Blueshield计划为基础医学检测服务提供覆盖范围。博188金宝Medicare COVERS底座®CDX,粉底®液晶CDX,以及用于合格患者的底座®漏洞。底座CDX还由TRICARE涵盖合格患者。底座Heme此时具有有限的商业健康计划覆盖范围。

无论网络状况如何,所有商业健康计划覆盖范围都根据适用的卫生计划的医疗政策和特定患者福利水平。

FoundationAccess计划

FoundationAccess计划

Foun博188金宝dation Medicine FoundationAccess™计划通过覆盖率和计费过程支持提供商及其患者。对于每次测试,我们完成了福利调查并向我们预期的患者联系到可能会有港口费用。此外,我们通过帮助在必要时获得先前授权的提供商和患者,以患者同意对测试的卫生计划计费患者的健康计划,并呼吁拒绝。

Patient Outreach

我们与预期的袖珍成本联系到所有患者

事先授权

我们在需要时帮助获得先前授权(PAS)

上诉支持

We bill the patient’s health plan for the test and appeal denials as necessary

BodyAccess计划如何工作?

步骤1

收到基础医学综合基因组分析(CGP)博188金宝试样后,基金会医学将向患者的保险公司伸出援手,以获得详细的福利信息(例如,确认保险资料,未履行扣除金额和实验室福利级别)。

第2步

博188金宝基础医学将确定订单是否需要事先授权(PA),并试图代表患者提交PA请求,如果基础医学是必要的,并且卫生计划将允许基础药物寻求PA。

在治疗医生的情况下必须苏bmit the PA request, Foundation Medicine will contact your office and provide the information to use when submitting a PA request.

第3步

博188金宝基金会医学将主动地向所有患有预期购买的患者达到预期的患者,以讨论有关其提供者订购的测试的高水平信息,他们可以期望用他们的标本发生,以及基金会采购计划如何通过覆盖范围和报销过程。

当我们期望患者没有订购的CGP测试没有任何口袋费用时,他们不会通过电话接收外展,但会收到邮寄材料,通知他们我们希望他们没有of-他们的基础药物CGP测试的口袋费用。博188金宝

先前授权支持

事先授权

博188金宝基础医学理解,现有授权要求可能对患者获得综合基因组分析的挑战。为了支持完成先前授权要求,何时:

  • 博188金宝基础医学is aware of a prior authorization requirement, and

  • 博188金宝基础医学能够提交以前授权,

博188金宝基础医学will submit prior authorization for FoundationOne CDx, FoundationOne Liquid CDx, and FoundationOne Heme.

如果基博188金宝金会医学无法提交先前授权,并且只有订购提供商能够提交,基金会医学将联系订购医师,以告知他们事先授权要求。

经济支援

财务援助计划

经济援助可用于具有与基础医学检测相关的折价的合格患者。博188金宝财务援助是基于需求,可以在测试过程中的任何时候申请。*付款计划也可能可用。

A financial assistance application (FAA) can be filled out在线的或通过联系我们的护理团队:

电话:888.988.3639

电子邮件:care.team@foundationmedicine.com

如果患者经历财务状况的变化,他们可以通过更新他们的财务援助申请表和/或提交额外文件记录更改或新信息来重新申请。

医疗补助患者:

由国家管理的医疗补助计划涵盖的患者自动获得100%的财政援助,以便根据我们的财务援助计划进行测试。管理医疗补助计划的患者仍需要填写财务援助申请表。†

保险患者要求将其作为自付的费用:

博188金宝基础医学will not apply a financial assistance award to a patient’s bill if the patient has insurance but elects to not have their insurance billed and requests to be billed as a self-pay patient.

Medicare覆盖范围和合规性

Medicare报道

博188金宝基础医学’s tests may be covered by Original Medicare1和医疗保险优势2

FoundationOne®CDx and FoundationOne®Liquid CDx

Covered3if all the below patient coverage criteria are met. An ABN is required if the patient does not meet the patient coverage criteria or if the person ordering the test is not a treating physician.4由原始医疗保险保险的患者1并满足覆盖范围的临床标准没有袖足费用。

患者报道标准

一世。患者已被诊断为固体恶性肿瘤; AND

II。患者占用复发,复发,难治性,转移性,orAdvancedsTAGE III或IV癌症(仅需要达到赛中的一个); AND

III。Patient has not been previously tested with the same test using NGS for the same cancer genetic content; AND

iv. Patient has decided to seek further cancer treatment (e.g., therapeutic chemotherapy)

FoundationOne®Heme

Covered5if all the below patient coverage criteria are met. An ABN is required if the patient does not meet the patient coverage criteria or if person ordering the test is not a treating physician4由原始医疗保险保险的患者1并满足覆盖范围的临床标准没有袖足费用。

患者报道标准6

一世。Patient has been diagnosed with refractory/metastatic acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), myeloproliferative neoplasms (MPN) or patient has a suspected myeloid malignancy with an undefined cytopenia for greater than 4 months, and other possible causes have been reasonably excluded, AND 

II。Patient has not previously received or is not currently receiving NGS testing on the specimen for which the test is currently being ordered, AND 

III。患者尚未用同样的遗传含量进行相同的测试测试 

可以找到由Medicare覆盖群岛®群体的癌症类型的ICD-10诊断码列表这里

Medicare Compliance

博188金宝基础医学致力于在其业务的所有方面做出正确的方式,通过提供及时可靠的客户服务,以及负责任地和正确的服务来为其服务进行计费。金博宝188亚洲体育app遵守Medicare规则和法规对于实现这一目标至关重要。

One of the more complex Medicare billing rules with which Foundation Medicine, and its customers, must comply, is the so-called 14-day rule. The 14-day rule helps to establish who will be billed for a test provided to a Medicare patient. In some cases, Medicare is billed directly for Foundation Medicine testing. In other cases, the 14-day rule requires that Foundation Medicine bill its hospital customers for testing that is performed on Medicare patients.

The “Date of Service rule” under applicable Medicare rules determines whether or not the clinical laboratory service, is bundled into the diagnosis-related group (DRG) payment made to the hospital for in-patients.

请查看我们14-Day Rule Billing Requirements确定谁受到影响。

Advance Beneficiary Notice

ABN Requirements

When patients insured by Original Medicare (i.e., Medicare administered by the federal government; not Medicare Advantage, which is administered by private health plans) have Foundation Medicine testing ordered by a treating physician and do not meet the coverage criteria set forth in an applicable National Coverage Determination (“NCD”) or Local Coverage Determination (“LCD”), the Centers for Medicare & Medicaid Services (“CMS”) requires that patients complete an Advance Beneficiary Notice (“ABN”) prior to receiving non-covered services.

The ABN informs Original Medicare patients that they may have financial responsibility for services ordered by their healthcare providers. If Foundation Medicine determines that a patient with Original Medicare does not meet coverage criteria, we will attempt to contact the patient (and treating physician as necessary) to obtain an ABN if one is not submitted with the Test Requisition Form (“TRF”).

ABN Form:

Medicare ABN (English)

Medicare ABN(Español)

Medicare ABN (Chinese)

补充笔记

*博188金宝基金会医学的财务援助计划仅适用于在美国和美国领土内订购的考试的患者。

博188金宝基础医学目前不是医疗补助提供者。博188金宝基础医学确实,在某些情况下,法案管理了Medicaid计划,允许这样做。

开发了底座血红素及其基础药物的性能特征。博188金宝它尚未得到美国食品和药物管理局的清算或批准。有关该实验室开发测试的更多信息,请参阅技术规格FoundationMedicine.com/f1h.

1Medicare administered by federal government.

2Medicare administered by private insurers.

3按“用于治疗医疗保险受益者的下一代测序(NGS)的决定 - CAG-00450R。“(见附录B)

4“治疗医师”是医生,如§1861(r)§1861(r),他们为特定医疗问题提供咨询或对待受益人,并在管理中使用诊断测试的结果the beneficiary’s specific medical problem. More information is available athttps://www.cms.gov/regulations-anguidance/guidance/transmittals/downloads/r80bp.pdf.

5National Government Services, the local Medicare Administrative Contractor with jurisdiction over testing performed by Foundation Medicine at its Cambridge, MA laboratory for Original Medicare beneficiaries, does not have a Local Coverage Determination (LCD) for liquid biopsy next generation sequencing >50 genes. Coverage is determined by National Government Services on a case-by-case basis.

6Per the“Local Coverage Determination (LCD):MolDX: NEXT-GENERATION Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies (L38047)”

需要更多细节?

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重要的安全信息

Select

FoundationOne CDx

BoastOne®CDX是一个基于定性的下一代测序体外晚期癌症患者的实体肿瘤诊断试验,仅供在处方使用。该试验分析324个基因以及基因组特征,包括微卫星不稳定性(MSI)和肿瘤突变负担(TMB),并且是鉴定可能根据经批准的治疗产品标记的特定疗法受益的患者的伴侣诊断。可以报​​告额外的基因组发现,并且不规定的或决定性用于标记使用任何特定的治疗产品。使用测试不保证患者将与治疗匹配。否定结果不会排除发生变化的存在。有些患者可能需要活组织检查。对于完整的标签,包括伴侣诊断指示和重要风险信息,请访问www.f1cdxlabel.com.。 

FoundationOne Liquid CDx

Bodaine®Liquidcdx仅用于处方使用,是基于定性的下一代测序体外实体肿瘤晚期癌症患者的诊断试验。试验分析利用循环无细胞DNA的324个基因,并批准用于报告311基因中的短变种,并作为鉴定可能从特定疗法治疗的患者(在预期用途中列出的表1中列出的患者诊断的伴侣诊断按照批准的治疗产品标记。可以报​​告额外的基因组发现,并且不规定的或决定性用于标记使用任何特定的治疗产品。使用测试不保证患者将与治疗匹配。否定结果不会排除发生变化的存在。对于伴随诊断突变阴性的患者应该反应到肿瘤组织测试和使用FDA批准的肿瘤组织测试确认的突变状态,如果可行。对于完整的标签,包括伴随诊断指示和完整风险信息,请访问www.f1lcdxlabel.com.