Lab's Non-Coverage Notice Deters Medicare Patients
However, the version of the form Quest is distributing does not inform patients that Medicare covers the test every three months. The form includes this language that Medicare officials say is problematic:
- "Medicare does not pay for these tests for your condition."
- "Medicare does not pay for these tests as often as this (denied as too frequent)."
- "Medicare does not pay for experimental or research use tests."
- The "estimated cost" is $66.
This form "does not comply with the standards for valid ABN issuance," Medicare's Jennifer Smith, director of the Division of Appeals Policy and Evelyn Blaemire, Senior Health Insurance Specialist, said in an e-mail response to HealthLeaders Media.
The rule specifies that the provider "must clearly indicate on the ABN which portions of the pre-printed information are applicable."
The Quest form has been in place for about two months in a region covering eight Southern California counties, or about 21 million people. Of those, about 13% are Medicare beneficiaries. More than 20% of Medicare beneficiaries are estimated to have diabetes, or about 554,000 people in this area who should receive quarterly A1c tests. Quest is one of two major labs serving this population. The other, LabCorps, does not use these forms, Speckart says.
- CMS Mulls Income-Adjusting MA Stars
- As Retail Clinics Surge, Quality Metrics MIA
- Providers Prep for New Payment Models as Population Health Grows
- Providers' Push to Consolidate Roils Payers
- Former NQF Co-Chair Linked to Conflicts of Interest in Journal Probe
- 3 Ways to Rev Employee Development Programs
- No Employee Satisfaction, No Patient-Centered Culture
- 6 Not-So-Good Reasons for Avoiding Population Health
- Medicare Cost, Quality Data Tools Weak, Says GAO
- Aligning Executive Compensation with Provider Mission