Beneficiaries Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Beneficiaries and links to relevant pages within the course.
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| Advance Beneficiary Notices (ABNs) Advance Beneficiary Notices (ABNs) allow laboratories to bill Medicare patients directly for specific tests that are not covered by Medicare.
A laboratory cannot bill a Medicare Beneficiary for a laboratory test unless it notifies the patient in writing that Medicare is not going to pay for the test.
This notice is called an ABN.
The beneficiary can choose not have the test performed if they do not want to pay for it.
Laboratories cannot make all Medicare beneficiaries sign ABNs.
The ABN must contain the specific name of the test.
The ABN must give a specific reason the laboratory thinks payment for the test will be denied.
The beneficiary should sign the ABN and be given a copy.
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| Advance Beneficiary Notices (ABNs) A Laboratory may not bill a Medicare Beneficiary for a test unless it notifies the patient in writing before the testing is done that Medicare is not going to pay for the test. This notice is called an ABN.
Laboratories cannot make all Medicare beneficiaries sign ABNs.
The ABN must contain the specific name of the test and give a specific reason the laboratory thinks payment for the test will be denied.
The beneficiary should sign the ABN and a copy should be sent to the laboratory and one given to the beneficiary.
The billing department must have evidence that the ABN has been signed before it bills a patient.A laboratory may bill Medicare even though it knows it will not be paid when it has evidence an ABN has been signed.
A modifier (GA) must be added to the CPT code for a test where an ABN has been signed.
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| Client contracts A laboratory that receives referrals from a nursing home or Skilled Nursing Facility (SNF) should have a written agreement with that facility:
The Agreement should define billing and documentation responsibilities.
The facility should be responsible for determining the payment status of its patients and is liable for submitting incorrect payment information to the laboratory.
Fees should be consistent with other similar customers.
A laboratory that provides services to a Home Health Agency treating Medicare/Medicaid beneficiaries should have a written agreement with that agency:
The Agreement should define billing and documentation responsibilities.
The Agreement should place the responsibility on the Home Health Agency to establish that all patients receiving laboratory services are "homebound" as defined by Medicare.
Fees should be consistent with other similar customers.
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| Client contracts A laboratory that receives referrals from a nursing home or Skilled Nursing Facility (SNF) should have a written agreement with that facility: The Agreement should define billing and documentation responsibilities. The facility should be responsible for determining the payment status of its patients and is liable for submitting incorrect payment information to the laboratory. Fees should be consistent with other similar customers. A laboratory that provides services to a Home Health Agency treating Medicare/Medicaid beneficiaries should have a written agreement with that agency: The Agreement should define billing and documentation responsibilities. The Agreement should place the responsibility on the Home Health Agency to establish that all patients receiving laboratory services are "homebound" as defined by Medicare. Fees should be consistent with other similar customers. | View Page |
| Changes to ABN, Effective March 1, 2009 Beginning March 1, 2009, providers (including independent laboratories), physicians, practitioners, and suppliers are required to use a newly revised ABN form --Form CMS-R-131-- for all situations where Medicare payment is expected to be denied. The revised ABN replaces the existing General Use ABN, ABN-G (Form CMS-R-131G), and the Laboratory ABN, ABN-L (Form CMS-R-131L), and NEMB (Form CMS-20007). An example of the new form is included on this page as a resource. The revised form will continue to be used for notifying beneficiaries of Medicare denial reasons, but it may also be used to provide voluntary notification of financial liability. The revised ABN still permits pre-printing of lab-specific key information (blanks A - D) and still permits the use of the same denial reasons that were used with the former ABN-L (Blank E). Three commonly used reasons for noncoverage are: Medicare does not pay for this test for your condition. Medicare does not pay for this test as often as this (denied as too frequent). Medicare does not pay for experimental or research use tests. There must be at least one reason applicable to each item or service listed in Blank (D). The same reason for noncoverage may be applied to multiple items in Blank (D). | View Page |