Diabetic patients on Medicare can receive a single quarterly Hemoglobin A1c test without incurring out-of-pocket charges. If this frequency is exceeded, the patient must pay for the test, which costs about $66. But, the patient is only responsible for the fee if the provider has them sign an “Advance Beneficiary Notice of Noncoverage (ABN) form that explains their financial responsibility if they have the test done more frequently than once a quarter. If a provider does not have the patient sign the form, they cannot charge the patient for the test if Medicare denies the claim. This would leave the provider (in this case Quest) on the hook for the cost of the test.
Quest Diagnostics has reportedly been providing ABN forms over the last two months to diabetic patients on Medicare in an 8 county region of Southern California. It is estimated that approximately 554,000 people in this region are diabetics on Medicare, but is not clear exactly how many people have received the ABN form so far.
So what’s the big deal about Quest’s form? It does not explain to people that they are entitled to one hemoglobin A1c test per quarter. An endocrinologist interviewed for the story said that about 1/3 of diabetic patients in his 5 physician practice are skipping the test after they receive the form. Obviously, hemoglobin A1cs are very important in the management of diabetics, so that is not good, to say the least. Medicare officials say the language on the form does not comply with Medicare standards and is a violation of Medicare rules.
So why is Quest doing this? A spokesperson for Quest says that the test is sometimes ordered too frequently because of ineffective communication between doctors.
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…
This rationale would make sense if the forms were telling people they could still get one test per quarter, but they are not. They are basically telling patients they are not eligible to receive any A1cs without paying for them out of pocket.
The endocrinologist mentioned another troubling aspect about this policy: It is undermining patient confidence in the care he provides to his patients. He says some of his patients are asking:
‘Why is Dr. Speckart doing this if the government doesn’t pay for it?’ It probably undermines the confidence they have in us. Because of this, some of our physicians have elected not to use Quest anymore for lab work.
In addition, this could negatively impact his revenue. Because Medicare is increasingly shifting to pay-for-performance metrics, physicians who have lower percentages of diabetic patients with quarterly A1cs can be financially penalized.
Interestingly, the Quest spokesperson would not answer a question about whether this form is being distributed anywhere else besides Southern California.
The Medicare spokespeople say they are re-educating Quest about the forms. We’ll see if anything changes.
From HealthLeaders Media (Full story at Lab’s Non-Coverage Notice Deters Medicare Patients):
The national blood testing lab Quest Diagnostics has been handing thousands of Southern California Medicare patients with diabetes a “non-coverage” notice that physicians say is provoking patients to reject their essential A1c tests, which federal officials say violates Medicare rules.
“This is a terribly ill-conceived administrative move that was done without consideration of the tremendously negative impact it is having on patient care,” says Paul Speckart, MD, a San Diego endocrinologist. When patients in the practice he shares with four other doctors receive this form, “about one-third are canceling the test.”