National Coverage Determinations (NCD's) is a document for diagnostic laboratory testing stating The Centers for Medicare and Medicaid (CMS) policies with respect to circumstances under which laboratory test(s) will be considered reasonable and necessary, and not screening, for Medicare purposes. Regional Pathology Services accepts Medicare assignment and is not allowed to bill Medicare beneficiaries for the NCD tests listed below unless an ABN is executed by the provider that tells the beneficiary in advance of the service that they will be responsible for the payment of the test(s) if Medicare should deny payment.·
ABN’s should be executed when:
These policies are updated every three months, with revisions published between final publications. It is ideal to use the latest version of the NCD policies.
It is the policy of Regional Pathology Services and The Nebraska Medical Center to ensure that an appropriate Advanced Beneficiary Notice (ABN) is obtained from Medicare beneficiaries for laboratory tests prior to collection of the specimen(s) that are deemed to be not reasonable and necessary.
Effective January 1, 2005 all laboratory test(s) requests for Medicare patients that does not have a diagnosis that meets the NCD guidelines for medical necessity and do not have an ABN attached, will be billed directly to the clinic/office that initiates the test order. Testing that does not require an ABN will be billed to Medicare. Blanket or routine ABN forms are nt allowed by CMS. ABNs should be executed when non-payment is anticipated.
ABN Usage Overview
Local Coverage Determinations (LCD’s) refers to the same types of exclusions as the NCD policies. Medical fiscal intermediaries or carriers have such exclusions in their policies. In addition to the NCD policies the Medicare billing contractor for Regional Pathology Services has enacted the following LCD policies.
Search the Center for Medicare and Medicaid web site.