​Medicare Billing Information

How is billing handled if I’m a Medicare patient?

Medicare pays for most laboratory testing, but there are exceptions. PeaceHealth Laboratories will bill you only if or when the Medicare carrier denies payment and lists “patient responsibility” as the reason. There are three laboratory services payment categories for which payment rules apply:

  • Medical necessity testing. Your doctor may decide a test is necessary regardless of Medicare’s payment rules, and some tests are covered only for certain diagnoses. You may be asked to sign an Advanced Beneficiary Notice or ABN (see question below), accepting financial responsibility in the event your diagnosis is not covered.
  • Screening tests. Medicare pays for certain screening tests on a fixed time schedule—such as Pap tests every two years. Tests performed more frequently than allowed may not be covered, so you will be asked to sign an ABN.
  • ​Non-covered tests. Certain tests are never covered by Medicare. In those cases, PeaceHealth Laboratories first bills Medicare for the tests; when the denial is received, PeaceHealth Laboratories bills you directly.

What is a Medicare ABN? 

An ABN (Advance Beneficiary Notice) is a form you will be asked to sign at a PeaceHealth Laboratories testing site or at your physician's office if the staff determines that Medicare may not pay for your laboratory testing. Medicare does not pay for all laboratory testing, and the ABN will explain which tests are not likely to be covered.

The fact that Medicare may not pay for a particular item or service does not mean that you should not receive it. There may be a good reason your doctor recommended it. The purpose of the ABN is to help you make an informed choice about whether or not you want to receive these laboratory tests, knowing that you might have to pay for them yourself.

Why didn’t Medicare pay for all my testing? 

Medicare does not cover all health care costs. Medicare may deny payment on tests deemed not medically necessary, screening tests performed more frequently than guidelines allow, or experimental or research use testing. Medicare will not make a determination on payment allowance until after the testing is performed; however, the ABN will help you determine which tests are likely to be declined for payment.​​

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