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Lab's Non-Coverage Notice Deters Medicare Patients

Cheryl Clark, for HealthLeaders Media, June 12, 2012

Additionally, he says some of his patients now ask, "'Why is Dr. Speckart doing this if the government doesn't pay for it?'  It probably undermines the confidence they have in us. Because of this, some of our physicians have elected not to use Quest anymore for lab work."

Kim Gotfredson, Quest's Senior Client Liaison for the Los Angeles Metro office, which covers services in San Diego, Orange, Los Angeles, Ventura, Kern, Riverside, San Bernardino, and Imperial counties, explained the new policy to HealthLeaders Media.

Quest: denying testing "is not our practice"
"Sometimes a provider doesn't necessarily know that the patient went somewhere else and had that test done. That's where it gets difficult. That patient may have gone to a specialist at one point, and then to a PCP (primary care provider) at another point, and that communication didn't get back to the specialist," she says.

Has this resulted in some patients walking away without getting the test? "Yes, for some of them that does happen, but not that much. A lot of patients do know this is not going to be an issue because they haven't had the test done for over three months," she said.

Gotfredson agrees that a patient who might see this form could misunderstand and "opt not to have the test done and that's not good patient care. I totally get where ... Dr. Speckart is coming from."  Gotfredson said she would take it up with other Quest managers, however she emphasized that patients are not being asked to pay $66 up front.

"It's not that this has been denied, because it hasn't been billed yet," she said.

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2 comments on "Lab's Non-Coverage Notice Deters Medicare Patients"


cheryl clark (6/15/2012 at 2:38 PM)
Mark [INVALID] the ABN form being distributed lists all three reasons, side-by-side, in the boxes.

Mark Sires (6/13/2012 at 4:55 PM)
If Quest's ABN indicates all three reasons, then it is noncompliant. If it only indicates that Medicare doesn't pay as often as this (which is the REQUIRED verbage per CMS guidelines), then this story is wrong. This is what has to be done. There is no mechanism for Quest, or any other laboratory, to verify the last time a patient had the test done. Therefore they have to provide an ABN for every time limited test. Medicare patients are free to get their testing done at any laboratory, so they can't assume that the last time they performed the testing was the last time the test was performed on this patient. The REAL story is that CMS implemented these time limited tests with no mechanism for laboratories to verify coverage. This is a CMS problem, not a Quest problem. If CMS wants to fix this, then they need to change the rules so a laboratory only has to provide the ABN if the test was performed by their lab within the limited time. If CMS determines that the testing was performed at another lab within the limited time frame, then the lab should be free to bill the patient even though an ABN was not produced.