The Apex Laboratory Home Visit Request Form is a one-page PDF that an ordering physician or medical provider uses to schedule a mobile phlebotomist to draw blood or collect other specimens at a patient’s home. You can download it from apexlabinc.com and submit it by fax or through the company’s online scheduling system. The form does double duty as both the lab requisition and the scheduling request, so an incomplete section is enough to stall the visit.
Before you fill anything in, decide which of the two visit types applies, because that choice drives who pays the travel fee.
- Medically necessary home visit. By signing the form, the ordering physician certifies that the patient is homebound and that the visit and the tests are medically necessary. Medicare or the patient’s insurance covers the collection fee, travel, and tests.
- Patient-billable home visit. When medical necessity is not certified, insurance is still billed for the draw and the tests, but the patient pays the travel fee out of pocket.1Apex Laboratory. Apex Laboratory Home Visit Request Form
What to Gather Before You Start
The form pulls information from several sources. Having everything in front of you prevents the back-and-forth that delays scheduling.
- Patient demographics. Full name, date of birth, sex, Social Security number or other unique identifier, home address, and a separate collection address if the draw will happen somewhere other than the primary residence.
- Contact numbers. Home phone, cell phone, and at least one alternate contact with their phone number. The technician calls the night before the visit, so the numbers have to be ones someone will actually answer.
- Insurance details. Medicare number, Railroad Medicare number, AARP Medicare Complete information, or the name and policy number for other insurance. If the policyholder is someone other than the patient, you need the policyholder’s name and the relationship (self, spouse, or dependent).
- Ordering provider information. Physician last and first name, office phone and fax, agency name if applicable, and the provider’s National Provider Identifier.
- Test names and ICD-10 diagnosis codes. Each test needs a matching diagnosis code. The form warns in bold that orders cannot be processed without an appropriate diagnosis, and certain Medicare Limited Coverage Tests need a more specific code to avoid denial.1Apex Laboratory. Apex Laboratory Home Visit Request Form
The coding requirement is not an Apex quirk. Under the Affordable Care Act, the ICD-10-CM code set is used across covered entities for encoding diagnoses on Medicare billing claims for clinical laboratory services.2Centers for Medicare & Medicaid Services. Lab NCDs – ICD-10 Normally the physician’s office handles it, but if you are coordinating the form yourself, make sure the codes are filled in before you send it.
Filling Out the Form Section by Section
Ordering Healthcare Provider and Agency
Start at the top. Enter the provider’s last name, first name, office phone, and fax number. If the provider works through a home health agency or practice group, include the agency name and the Apex account number if one has already been assigned. The NPI identifies the ordering provider in all billing transactions with Medicare and private insurers.3Centers for Medicare & Medicaid Services. National Provider Identifier Standard
Patient Information
Fill in the patient’s last name, first name, date of birth, sex, and Social Security number or other unique identifier. The home address goes in the first address block. If specimens will be collected somewhere else, use the second address line labeled “Address (where specimen is to be collected).” Add a home phone, cell phone, and an alternate contact person with a working number. That alternate is the backup if the technician cannot reach the patient.
Tests Requested
List each test by name in one column and its matching ICD-10 diagnosis code in the adjacent column. Mark whether the patient needs to fast. This is where most rejections happen: a missing, vague, or unsupported diagnosis code means Apex will not schedule the visit. A narrative description of the diagnosis is acceptable if a code is not immediately available, but a code is always preferred.1Apex Laboratory. Apex Laboratory Home Visit Request Form
Billing Information
Check the box for the patient’s coverage: Medicare, Railroad Medicare, AARP Medicare Complete, other insurance, bill patient, or bill agency. For non-Medicare insurance, write in the company name and policy number. If the patient is not the policyholder, enter the policyholder’s name and the relationship (self, spouse, or dependent). “Bill Patient” is the box for the patient-billable visit type where the patient covers the travel fee.
Schedule
Choose one-time or recurring. Recurring options include weekly (specifying how many times per week or every how many weeks) and monthly. Every order needs a start date. Standing orders also need an end date and cannot exceed six months. Mark the days of the week the technician should visit. Routine blood work ordered every four weeks for monitoring can be set up as a single standing order instead of a new form each time.
How to Submit the Form
Apex accepts the completed form by fax or through its web-based scheduling system. The fax number depends on the service region:
- Nassau, Suffolk, Queens, and Brooklyn: 631-753-3910
- Manhattan, Staten Island, Bronx, and Westchester: 914-963-4709
- Toll-free fax: 1-877-521-8482
For online submission, go to apexlabinc.com and use the web-based scheduling system, which requires a one-time registration. The general number is 631-753-3900 for questions or to confirm receipt.1Apex Laboratory. Apex Laboratory Home Visit Request Form Send all pages in a single transmission. If the physician’s order or prescription is a separate document, fax it along with the form so Apex can process everything together.
Service Areas
Apex’s mobile phlebotomy service is regional. In New York, it covers Nassau, Suffolk, Queens, Brooklyn, Manhattan, Staten Island, Bronx, and Westchester counties. In South Florida, coverage extends to Palm Beach, Broward, Martin, and St. Lucie counties, with operations based in Boynton Beach.4Apex Laboratory. South Florida – Apex Laboratory A form submitted from outside those areas will not produce a scheduled visit, so confirm your ZIP code falls within coverage before sending it in.
What Happens After You Submit
Apex verifies the insurance information and confirms the diagnosis codes support the ordered tests. Once that review clears, the visit enters the routing schedule. Technicians call all patients the night before the scheduled visit between 6:00 and 9:30 p.m. to confirm. If they reach voicemail, they leave a message and call again the following morning.5Apex Laboratory, Inc. Apex Laboratory Home Visit Request Form Keep your phone close during that evening window so you do not miss the confirmation.
The exact arrival time depends on the technician’s route and the volume of visits in the area that day, so the window can shift. Have the insurance card and a form of identification ready when the technician arrives for identity verification before any draw.
For a patient-billable visit, ask about the current travel fee before you submit. The form itself does not list a dollar amount, and calling 631-753-3900 ahead of time keeps the cost from being a surprise after the fact. For a recurring standing order, the schedule continues automatically until the end date on the form, up to the six-month maximum, after which the physician’s office needs to submit a new form to keep the series going.1Apex Laboratory. Apex Laboratory Home Visit Request Form