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
- 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
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