The A1c test Medicare Medicaid Noncoverage Penny wise Pound Foolish ?

A  form called an "Advance Beneficiary Notice of Noncoverage," or ABN is a Medicare template it is intended to warn patients that Medicare imposes limits on coverage.
 The A1c test, which doctors typically order every 90 days, is covered only once every three months. If more frequent tests are ordered, the beneficiary needs to know his or her obligation to pay the bill, in this case, $66 per test. when the  actual cost of the test to the  clinic is  about 10 $

If providers do not give patients these ABN forms to sign and the claims are denied, the provider is not entitled to collect directly from the patient.

"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 and the four other doctors in his building "were astounded."
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,"

let us not be  Naive.
LabCorp and quest are least bothered whether the Health of the patient population improves or not. their Bottomline depends more on sicker patients getting more testing done.

What I do not understand is the fatuousness of medicare Administrators who decided on these rules that they will not cover the test unless there is an  ICD code related to Dm2  or prediabetes.and  will not pay for more testing than once in 3 months.

the same Federal Govt wants certain numbers for Hba1 testing to qualify for UDS measures

Quest: denying testing "is not our practice""Sometimes a provider doesn't necessarily know that the patient went somewhere else and had that test done. That's where it gets difficult. That patient may have gone to a specialist at one point, and then to a PCP (primary care provider) at another point, and that communication didn't get back to the specialist," she says.

Has this resulted in some patients walking away without getting the test? "Yes, for some of them that does happen, but not that much. A lot of patients do know this is not going to be an issue because they haven't had the test done for over three months," she said.

Gotfredson agrees that a patient who might see this form could misunderstand and "opt not to have the test done and that's not good patient care. I totally get where ... Dr. SpX is coming from."  Gotfredson said she would take it up with other Quest managers, however she emphasized that patients are not being asked to pay $66 up front.

"It's not that this has been denied, because it hasn't been billed yet," she said.

Impact on physician performance measures
The impact of Quest's policy has ramifications on physician performance metrics as well. Medicare's Physician Quality Reporting System or PQRI, penalizes reimbursement for doctors with lower percentages of diabetes patients who obtain quarterly A1cs.

The American Association of Clinical Endocrinologists in Jacksonville, FL, had not heard about the Quest's ABN language. But its director of member advocacy, Anita Sumpter, said after seeing the form, "The physicians may need to start informing their patients prior to them going to have blood work done what is an ABN and why Quest is presenting it to them.  They may also need to work with Quest to get them to provide a better explanation why they are providing the ABN to the patient.

"Quest has to do their due diligence in appealing denied claims before billing the patient for denied services.  They could get into serious trouble with this type of practice because CMS does not recommend routinely providing patients with ABNs."

Speckart says the issue has created enormous headaches for his office, which sees a large share of diabetes patients. Quest's form "has inserted another layer of difficulty in a practice already grappling with an increasing number of regulations," he says.

For Medicare officials Smith and Blaemire, the bottom line is patient care.

REALLY? What a bunch of  Bull

 "When the ABN is issued consistent with Medicare policy, it serves to protect both providers and beneficiaries from unexpected financial liability and should not deter beneficiaries from receiving covered care that is medically reasonable and necessary," they wrote.

They said they "will follow up with Quest to re-educate the provider on the delivery requirements for ABNs."  They add, "providers must exercise caution before adding any customizations beyond these guidelines, since such alterations could result in the ABN being invalidated and make the provider (in this case Quest) liable for non-covered charges."