Billing and Collections

Ask the Experts: Stat Order Designation

July 17, 2017 4:09 pm

Our health system does not have a written policy for handling stat orders (i.e., when patients walk into one of our hospitals with stat orders and need registration assistance).  

I am seeking guidance on time frames that define stat orders, whether we can require all patients presenting with stat orders to sign waivers accepting financial liability for the testing, and whether our health system could be held liable if patients opt to wait for a health plan authorization or proceed to our emergency department to receive the test and then experience health issues during the delay.

Answer 1: Stat is a designation assigned to how quickly a test is given and results provided. It is not a medical condition or recognized as a type of priority for services—except internally to receive results for particular tests before others. In many cases, it is more a convenience for the practitioner then a medically urgent situation.

You can reference the UB04/837 I definition of priority (type) of admission/visit, form locator 14 in the UB-04 specifications manual. The distinction between emergency, urgent, and elective is clear, and the scenarios described below would indicate that even if physicians order stat tests, a health plan could consider it elective in which case third-party payer protocols would apply.   

As far as time frames for stat orders, the consistent answer is that stat is immediate. It is an emergent need and should be no more than 15 minutes from order to patient.

If services follow the 15 minutes from order to test protocol, I recommend using priority type of admission/visit 2 urgent (the patient requires immediate attention for the care and treatment of a physical or mental disorder on the claim to indicate an urgent condition.)

Regarding patient financial liability waivers, consult with your legal department. However, because the Emergency Medical Treatment and Labor Act (EMTALA) does not apply here, and the patient presents for service, this type of protocol would and should apply.

Also, discuss with your legal department what the healthcare provider liability is if patients refuse services. I also recommend including key clinical stakeholders in this conversation.

Your organization’s legal responsibilities related to giving patients the alternative to visit the ED depends on your definition of stat from a clinical perspective and how it is applied internally.

This question was answered by: Suzanne Lestina, FHFMA, CPC, vice president, client innovation, AvadyneHealth, and a member of HFMA’s First Illinois Chapter.

Answer 2: Stat means “now” or at best “urgent” because it means the testing should “jump the queue” of other specimens waiting to be processed because the result is needed to respond quickly to the condition of the patient standing in front of the provider ordering the stat test. It really has no place on test orders that patients walk in with.

My suspicion is that this is a test ordering practice that has arisen within your physician community over time—“stat” has come to mean “important.” University of California, San Francisco’s hospital lab policy defines turnaround times for stat orders and documents what tests they will perform on a true stat basis.

I would ask the departments receiving these orders what stat means to them and look for patterns in who is designating stat orders to focus education efforts where they will do the most good.

This question was answered by: Marty Knutson, JD, CPC, health lawyer, San Diego.

Answer 3: The definition for stat test orders is that the results are needed for emergency situations. For example, a physician writing an order as stat a week before the patient presents for testing would not be considered a stat situation.

This question was answered by: Brenda Loper, regional director of access services for four Sentara Healthcare hospitals. 

The information provided through the Forum’s Ask the Expert service does not constitute legal advice, even when the advice is provided by lawyers. You need to obtain your own legal counsel for legal advice, and consider the laws and regulations that govern your state. The content and opinions expressed are those of the Forum experts, and not that of their employers or of HFMA. HFMA does not endorse the material or warrant or guarantee its accuracy. The responses are based only on the specific facts or circumstances provided. Forum experts cannot be held liable for outcomes related to any information provided.

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