Diagnostics and laboratory

Our hospital will provide you with a list of current test methods, performance specifications, specimen requirements, Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, pricing structure and testing site information. Please let us know if there is any information you require regarding testing methodology or our performance.

We report all of your results within established turn-around times. Should there be a delay in reporting your results, our laboratory and medical staff have established protocols to notify physicians when it is important for your care. If a problem arises that prevents timely result notification, then the physician will be informed regarding the new expected time of report.

It's important to know what is covered by your insurance. To help, the following are frequently asked questions about Medicare.

What is an advanced beneficiary notice (ABN)?

An ABN is a form that lets you know you may have to pay for a test your doctor has ordered if Medicare refuses to pay for it. Once you sign an ABN, the lab may bill you for the cost of the test.

Why do they want me to sign an ABN?

Although Medicare pays for most lab tests, it will not pay for some tests under certain circumstances. When this happens, our lab must ask you to pay. Consequently, we ask you to sign an ABN whenever Medicare appears to deny payment for a specific test the doctor has ordered. The reason you are being asked to sign an ABN now is that this is one of those occasions in which we or your doctor believe Medicare will not pay.

Do I have to sign the ABN?

No. You have three options:

1. You may sign the ABN and have the test performed. You can then be billed for the test.
2. You may refuse to sign the ABN and choose not to have the test done. However, in not having the test done, you will be going against the medical advice of your doctor. So we advise you to consult with your doctor before choosing this option.
3. You may refuse to sign the ABN and go ahead with the testing. Our lab will perform the test and you will receive a bill — even though you refused to sign the ABN. A witness will sign the ABN to indicate you have been advised of the ABN and refused to sign it but still want the test performed. Under Medicare guidelines, we are required to then bill you directly for the tests.

Why do you think Medicare will not pay for this test?

Medicare pays only for tests it considers medically necessary. Some tests are always considered medically necessary, but most tests fall in the middle — and may only be considered medically necessary under certain circumstances, depending on your diagnosis.

If the diagnosis the doctor lists is not one Medicare will accept for that test (or if the doctor does not tell the lab what the diagnosis is), the test will not be considered medically necessary, and Medicare will not pay for it.

If Medicare says the test is not medically necessary, why perform it?

Your doctor has made a medical judgment that you need the test. When your doctor says a test is medically necessary, they consider your personal medical history, any medications you may be taking and generally accepted medical practices.

When Medicare says a test is not medically necessary, it is not making a medical decision about your health. It is acting like an insurance company deciding what it will and will not pay. There are occasions when Medicare will not pay for services doctors think are important to your health. But as the ABN says, you have the option not to have the test done.

If you have questions about a specific test your doctor has ordered for you and why it is medically necessary, please consult with your physician.

Will I be automatically billed?

No, after the lab performs the test, we will ask Medicare to pay for it. If Medicare does pay for it, you will not receive a bill. You will only get a bill if Medicare denies the claim. Remember that if Medicare denies the claim, you may contest the denial if you think it was wrong.

Is Medicare more or less likely to pay if I sign an ABN?

Neither. The fact that you have signed an ABN will not affect Medicare's decision.

Will supplemental insurance pay for the test if Medicare does not?

Maybe. If you have a supplemental insurance policy — sometimes called a Medigap policy — contact the insurance company and ask whether the policy covers lab tests that are not covered by Medicare. If so, find out how to submit claims for payment under the policy.

Do I have to sign an ABN every time a new test is done?

No. You will be asked to sign an ABN only when the doctor or lab has good reason to think that Medicare will deny payment for the ordered test. There may be visits to the doctor's office or lab when you will be asked to sign an ABN and other visits when you will not. It all depends on the test and the reason for ordering it on that visit.

I haven't been asked to sign an ABN before. Why do I have to sign one today?

If you haven't been asked to sign an ABN before, there was no reason to believe Medicare would deny payment for tests ordered during previous visits. However, on this visit, your doctor or healthcare provider thinks Medicare will not pay for the test being ordered.

You should ask your doctor what the difference is between today's visit and other visits when you did not have to sign an ABN. The reason may be because:

• Your doctor ordered different tests on previous visits.
• This is the first time your doctor is ordering this particular test.
• This is the same test your doctor ordered before, but your diagnosis has changed — meaning the doctor is ordering the test for a different reason.
• This is the same test and the same diagnosis, but Medicare changed the rules from your last visit and no longer pays for the test under this diagnosis.