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Lab's Non-Coverage Notice Deters Medicare Patients



A national lab's use of a form intended to warn diabetic patients about Medicare's limits on coverage for a vital blood test is provoking some patients to reject testing. A Medicare official says the form does not comply with the standards for valid notices of noncoverage.



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.