If reimbursement is denied due to the lack of medical necessity, Medicare rules prohibit the laboratory or health care provider from subsequently billing the patient unless an Advance Beneficiary Notice (ABN) has been signed and dated by the patient prior to the service.
The ABN identifies the laboratory tests, gives the reason it is likely to be denied, assures that a patient understands that he/she may be responsible for payment if the test is considered to be medically unnecessary by Medicare, and allows the beneficiary or patient to make an informed decision whether or not to receive the service and pay for it out of pocket.
The patient always has the right not to sign the ABN, in which case the service will not be provided unless the physician is willing to pay for the service. If the patient refuses to sign an ABN, then Clinical Laboratory Partners will not collect the specimen for the affected test(s) and will inform the patient and the physician. |
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