Advocacy and Support

• AdvancedBC.org
• Alamo Breast Cancer Foundation
• American Cancer Society
• Association of Cancer Online Resources
• Avon Foundation for Women Breast Health Outreach Program
• AVON Breast Health Outreach Program
• Be a Survivor: Your Guide to Breast Cancer Treatment
• Breast Cancer Connections
• www.breastcancer.org
• BreastCancerTrials.org
• BCSM – Breast Cancer Social Community
• BCSM/Breast Cancer Social Media
• Cancer Information and Support Network
• CancerCare.org
• CaringBridge.org
• Cure
• Europa Donna
• FORCE
• Inspire
• Living Beyond Breast Cancer
• MyBCTeam
• MyLifeLine
• National Breast Cancer Foundation
• National Cancer Institute
• National Coalition for Cancer Survivorship
• Patient Resource
• Research Advocacy Network
• SHARE: Self-Help for Women with Breast or Ovarian Cancer
• Sharsheret
• Sisters by Choice
• Sisters Network, Inc.
• Susan G. Komen for the Cure
• The National Breast Cancer Foundation
• Tigerlily Foundation
• Triple Negative Breast Cancer Foundation
• Vital Options International
• WebMD
• Young Survival Coalition

Blogs

• HealthCentral.com Breast Cancer Blog Links
• HealthTalk Breast Cancer Blog
• My Breast Cancer Blog
• Breast Cancer Care’s Vita Blog
• Cancerwise
• Caroline’s Breast Cancer Blog
• Chemobrain…In the Fog
• Detrice Matthews
• HealthTalk Breast Cancer Blog
• Joan Lunden Blog
• Journeying Beyond Breast Cancer
• Let Life Happen
• Rethink Breast Cancer
• The Perks of Having Cancer

Family Support

•  Cancer Support Community
•  Stupid Cancer

Agendia CMS Compliance

Agendia, Inc. is committed to providing quality testing for patients and their treating physicians by offering timely results, reliable customer service, and adhering to responsible billing practices. As a part of Agendia’s regulatory policy, we follow all Federal & State requirements, based on applicable rules and regulations as it relates to Clinical Laboratory services.

What is the 14-Day Rule?

The “14 Day Rule” is a regulation set forth by the Centers for Medicare & Medicaid Services (CMS) that generally requires laboratories, including Agendia, to bill a hospital or hospital-owned facility for certain clinical and pathology laboratory services and the technical component of pathology services provided to Medicare patients when services are ordered less than 14 days after an inpatient discharge.

How do we determine the date of service?

In general, the date of service (DOS) for clinical diagnostic laboratory tests is the date of specimen collection unless the physician orders the test at least 14 days following the patient’s discharge from the hospital. In the latter situation, the DOS is the date the test is performed, instead of the date of specimen collection.

Who is impacted by the 14-Day Rule?

Hospitals and hospital-owned facilities where the patient’s specimen was collected for a hospital inpatient encounter.

Is there an exception to the Date of service (DOS) policy?

• The test is performed following a hospital outpatient’s discharge from the hospital outpatient department:
• The specimen was collected from a hospital outpatient during an encounter (as both are defined 42 CFR 410.2);
• It was medically appropriate to have collected the sample from the hospital outpatient during the hospital outpatient encounter;
• The results of the test do not guide treatment provided during the hospital outpatient encounter; and
• The test was reasonable and medically necessary for the treatment of an illness

Below is an outline of the scenarios under which the Medicare date of service rules will apply to Agendia’s tests. The decision to submit an order for testing should be guided by the clinical judgment of the ordering physician and should not be based on the application of any billing rules.

Status at Specimen Collection

Outpatient
Nonpatient
Inpatient; ordered >14 days after date of discharge
Inpatient; ordered >14 days after date of discharge

Medicare Billing
Agendia, Inc. bills Medicare

Agendia, Inc. bills Hospital