(bright upbeat music)
-[Narrator] Paperwork, it can be difficult, right?
But it also happens to be necessary.
It's the engine that keeps
the Sage cancer screening program moving,
a critical part of a life saving effort.
Let's take a few minutes
to sort out the Sage paperwork process.
How does it work?
Many clinics mail Sage paperwork to women
to complete before their clinic visit.
Others have women fill it out right on the spot
during an appointment,
and sometimes is to determine a woman needs Sage
after her appointment.
Sage can accept retro-enrollments
up to 120 days after the screening date.
Things go smoothly when forms are filled out completely
and submitted on time.
Women access the care they need
and clinics can be properly paid.
Let's have a look at the forms.
Sage uses three of them to enroll a patient
and capture screening information.
First is the Sage consent enrollment form.
It's four pages.
The patient completes the first three
and the clinician fills out the fourth.
This form is the first step in arranging screening,
is also critical for billing.
The forms first page includes a declaration of consent,
and requires a signature and date at the bottom.
By signing the patient agrees
that the clinic can share her information with Sage.
Don't forget to have the patient sign.
If the signature is missing,
Sage will return the form.
Each Sage enrollment form
is coded with an encounter number,
an alphanumeric code unique
to each clinic and patient.
This encounter number identifies
a patient's particular episode of care.
The code must be added
to the upper right hand corner of the enrollment form
and to all other paperwork
pertaining to the patient's care.
Don't forget this,
the encounter number is key to clinic payment.
If a patient returns to the clinic
a year later to be rescreened,
she'll fill out a new form
and be assigned a new encounter number.
Sage provides the encounter numbers.
Clinics can order forms at health.sageforms@state.mn.us.
Page 2 of the enrollment form
gathers other patient information,
address, date of birth, social security number.
While the full number isn't required,
obtaining the last four digits
helps the program link claims to services.
The patient's race, ethnicity and education
are all also collected on this page,
so that Sage can learn more about the women
and show the CDC, it's funder,
who the program helps.
The final questions on this page,
questions 17, 18 and 19,
are required and determine eligibility.
They ask patients about insurance status,
family size, and household income.
Without this information,
the form will be returned to the clinic
and payment for services will be delayed.
Page 3 ask patients for their medical history.
This information is helpful
for both Sage and its partner clinics.
The CDC uses this information
to understand the characteristics of the population served.
Page 4 is the last page,
and is completed by the medical provider.
We call it the visit summary.
A report that shares what happened during the visit
and identifies what tests were ordered.
Without this information,
Sage won't be able to pay
or assist with follow up on a patient.
Let's drill down a bit.
All information collected on this page is important.
In the patient's history section,
the date of the patient's last known clinical breast exam,
mammogram or Pap tests are collected.
In the Sage services provided this visit section,
you'll find the results counseling only line.
Sage covers consultation visits for women
whose test results are abnormal,
so providers can review the findings
and come up with a care plan.
If that's the situation,
clinics can check one of the boxes
on the forms results counseling only line,
to indicate either a breast or cervical abnormality.
This is the only information required
for a consultation visit.
The next two questions
address breast symptoms and family history.
While Sage typically covers screening
only for women ages 40 to 64,
it makes an exception for younger women
with breast symptoms
or a family history of breast cancer.
Clinics can get coverage for these under 40 women
simply by checking the boxes
indicating their special circumstances.
The next section gathers information about the CBE.
Was one done?
If so, what was the result?
If a breast ultrasound or mammogram was ordered,
this is the place to indicate it.
The last section focuses on cervical services, HPV,
colposcopy or endometrial biopsy tests and their results.
While Sage usually covers a Pap test every three years
or every five years if it's done with HPV code testing,
the program will cover more frequent Pap tests
for women who've had abnormal test results.
Checking the box for a surveillance Pap
will ensure Sage coverage.
In general, at least one of the listed services
must have been provided and noted
to receive payment for the office visit.
If required information isn't provided,
the form will be returned to the clinician for completion
and payment will be delayed.
To put it simply,
Sage covers many kinds of visits and tests,
from a simple exam or mammogram to a biopsy
as long as the care is related to breast
and cervical cancer prevention and detection.
One clarifying example is an endometrial biopsy.
Sage covers it to follow up on an abnormal Pap results
but not to investigate bleeding.
Everything Sage does
is about fighting breast and cervical cancer.
Let's have a look at the other Sage forms,
both of which are designed to capture
and transmit the results of screening tests.
Once they're properly completed and submitted,
Sage is able to pay for the services provided.
The imaging summary form follows a patient
when she goes in for a mammogram.
The patient's encounter number
must appear in the upper right of this form too.
It's up to the mammogram provider
to complete the form and send it to Sage.
The Pap summary form takes a similar path,
following the patient to her Pap test.
The encounter number goes in the upper right corner.
The cytology lab records the PAP results on the form
and sends the results to Sage.
That's the paperwork process.
And as you can see, details really matter.
At the clinic, your role is to make sure
that the Sage enrollment form is properly completed.
So take one more look
and ask a few questions.
Has the patient provided the necessary information?
And, has she signed the form?
Does she meet the Sage qualifications?
And has the provider filled out page 4?
Is the encounter number in the upper right corner?
Does the billing office know to bill Sage?
If yes, then you're good to go.
Just fax or mail the forms to Sage and you're done.
That's it.
You've handled the paperwork.
You're helping to save lives.
(bright upbeat music)