Lab's Non-Coverage Notice Deters Medicare Patients
The national blood testing lab Quest Diagnostics has been handing thousands of Southern California Medicare patients with diabetes a "non-coverage" notice that physicians say is provoking patients to reject their essential A1c tests, which federal officials say violates Medicare rules.
"This is a terribly ill-conceived administrative move that was done without consideration of the tremendously negative impact it is having on patient care," says Paul Speckart, MD, a San Diego endocrinologist. When patients in the practice he shares with four other doctors receive this form, "about one-third are canceling the test."
The form, called an "Advance Beneficiary Notice of Noncoverage," or ABN, is a Medicare template intended to warn patients that Medicare imposes limits on coverage. The A1c test, which doctors typically order every 90 days, is covered only once every three months. If more frequent tests are ordered, the beneficiary needs to know his or her obligation to pay the bill, in this case $66 per test.
If providers do not give patients these ABN forms to sign and the claims are denied, the provider is not entitled to collect directly from the patient.
- How Top-Ranked MA Plans Earn Their Stars
- WellPoint Dominates Nearly Half of Markets, AMA Says
- CMS Offers Some ACOs $114M for 'Upfront' Costs
- Ebola: Second TX Nurse Diagnosed After Improper Protective Gear Application
- How Hospitals Can Become 'Upstreamists'
- Providers Ask HHS to Address EHR Interoperability Barriers
- 16 Medicare Advantage Plans Earn 5-Star Ratings
- The Drug Price Reform Debate
- CMS' new investment model will help ACOs with health IT
- Ebola: A Call for Designated Hospitals