Lab's Non-Coverage Notice Deters Medicare Patients

Cheryl Clark, for HealthLeaders Media , June 12, 2012

Doctors 'astounded' at Quest's practice
He became aware of the new Quest practice two months ago—sooner than most doctors—because he sends his patients to a Quest blood draw center down the hall within his building. He heard feedback right away.

"Patients started to mention they didn't get their A1c because the lab had handed them this form saying it wasn't covered. It didn't sound right at all, because it flies in the face of standard medical practice for diabetes care," he says.

He called Quest, whose administrator confirmed Quest's new policy, he says. He and the four other doctors in his building "were astounded."

Speckart says the A1c is the best way clinicians have to assure sufficient levels of blood sugar are maintained or whether insulin dosages should be altered. Failure to monitor quarterly can result in insidious deterioration to vascular and organ systems, such as eye, kidney, nervous system and heart.  "Without this, the potential for getting out of control is obvious," he says.

"Clearly, whoever designed this form did not think what the impact would be," he says, adding that doctors who haven't seen this in their patients will just have to wait a few months, when their regular patients return for their quarterly visits without their A1cs.

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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.




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