Evernorth Care Group

Summary Statement of Deficiencies D6054 TECHNICAL CONSULTANT RESPONSIBILITIES CFR(s): 493.1413(b)(9) The technical consultant is responsible for evaluating and documenting the performance of individuals responsible for moderate complexity testing at least annually, after the first year. This STANDARD is not met as evidenced by: Based on lack of competency evaluation documentation for review and interview with the facility personnel, the technical consultant failed to evaluate and document the performance of individuals responsible for moderate complexity testing at least annually. Findings include: 1. During the survey conducted on May 4, 2022, the laboratory failed to provide documentation of a completed annual competency evaluation for one testing personnel from 2020, 2021 and 2022. 2. The facility personnel confirmed that the laboratory failed to provide documentation of a completed annual competency evaluation from 2020, 2021 and 2022 for the testing personnel indicated above. Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number (X3) Date Survey Completed Name of Provider or Supplier Street Address, City, State -- 1 of 1 --

Summary Statement of Deficiencies D5801 TEST REPORT CFR(s): 493.1291(a) The laboratory must have an adequate manual or electronic system(s) in place to ensure test results and other patient-specific data are accurately and reliably sent from the point of data entry (whether interfaced or entered manually) to final report destination, in a timely manner. This includes the following: (a)(1) Results reported from calculated data. (a)(2) Results and patient-specific data electronically reported to network or interfaced systems. (a)(3) Manually transcribed or electronically transmitted results and patient-specific information reported directly or upon receipt from outside referral laboratories, satellite or point-of-care testing locations. This STANDARD is not met as evidenced by: Based on review of patient test results maintained in the electronic health record (EHR) system, review of instrument test results, review of the laboratory form used to record test results and interview with the facility personnel, the laboratory failed to accurately report the D-Dimer test result for one patient. Findings include: 1. The laboratory performs testing in the specialty of Hematology, with an approximate annual test volume of 5,328. The laboratory utilizes an electronic health record (EHR) system to maintain patient test reports. It is the practice of the laboratory to manually enter test results into the EHR for each patient tested. 2. Review of D-Dimer test results in the EHR for patient #00219661 performed on 10/18/2018 indicated the test result of 0.334 ug/mL, however the instrument print out and laboratory form used to record the test result indicated the test result as 0.344 ug/mL. 3. No