Pathology/Lab Coding Alert

HCFA released a draft version of a new, one-page advance beneficiary notice (ABN) designed to be more readable and easier to understand. Simplifying the ABN was among the top priorities that doctors recently identified for HCFA to address.

Note: You can view the ABN draft on the Web at www.hcfa.gov/regs/prdact95.htm. Click the link just below the heading April 19, 2001 Information Collection Requirements in HCFA-R-131. The laboratory ABN is in the file R131LABN.doc.

Any physician or medical-equipment supplier furnishing and billing outpatient Medicare services must procure an ABN when it is expected that Medicare probably will not pay for a service because it is not considered reasonable and necessary. Physicians and suppliers can bill the patient for these noncovered charges only if a signed ABN is on file.

Although the ordering physician may obtain the signed ABN, HCFA has charged laboratories with the responsibility to maintain the document on file when the lab is billing for the services.

The revised laboratory ABN specifies, Medicare probably will not pay for laboratory tests listed below for the following reasons: 1. Medicare does not pay for these tests for your condition, or 2. Medicare does not pay for these tests as often as this, or 3. Medicare does not pay for experimental or research-use tests.

The ABN also advises the beneficiary to ask for a further explanation if he or she is unsure why Medicare probably will not pay, and to check how much the item or service will cost, either personally or through other insurance. The patient is then asked to check one of two options, and sign and date the form.

The first option reads, Yes, I want to receive these laboratory tests. The second option reads, No, I have decided not to receive these laboratory tests.