CMS moves closer to standardizing medicare's advanced beneficiary notice; lab organizations launch website for patients. (Washington Report).

Before getting into the latest developments regarding Medicare's Advanced Beneficiary Notice (ABN), we want to mention that the Laboratory Coalition's legislative "Fly-In," noted in last month's column, did not take place as planned on Sept. 11.

Representatives of various lab groups from around the country were scheduled to lobby Congress for passage of the Medicare Patient Access to Preventive & Diagnostic Tests Act (H.R. 1798, S. 1066) and other legislative priorities, but the tragic events of that day put their plans on hold.

"The bulk of the meetings were just starting, and then the order came to evacuate the buildings on Capitol Hill," says coalition member Mark Birenbaum, PhD, administrator for the American Association of Bioanalysts (AAB).

At this point the coalition is sending letters to all Congressional offices for which the group had meetings scheduled, Birenbaurn says. The letter "thanks the lawmakers for agreeing to meet with coalition members and informs them that when the time is appropriate, we want to get back together with them," he adds. "Washington Report" will keep you posted on the coalition's plans as they become available.

Now turn to federal efforts to standardize Medicare's ABN. The Centers for Medicare and Medicaid Services (CMS) recently issued new draft instructions implementing the ABN. They are designed to clear up any lingering questions about the ABN. Associations representing laboratory professionals continue to have suggestions about how to improve the ABN. They have given CMS some additional comments and hope more changes will be forthcoming.

ABN advises Medicare beneficiaries, before items or services are actually furnished, when Medicare is likely to deny payment for them. The ABN must identify the service or item for which denial is expected and clearly state the reason why. The standardized ABN is designed to be "more beneficiary friendly, more readable and understandable, with patient options more clearly defined," according to CMS.

One of the recent changes indicates that providers are allowed to give beneficiaries a single ABN for an extended course of treatment. This is expected to include laboratory tests provided on a regular basis under a standing order for nursing home patients, for example.

"That change was positive for us," says AAB's Birenbaum. AAB members believe this change is needed because some nursing home patients are not always competent to sign the ABN each time a lab test is required. Even so, Birenbaum says the information with regard to the extended course of treatment "is still not on the ABN itself and that is a concern to us, because the beneficiary or his or her representative may never see any of these instructions."

CMS also indicates that the new general ABN (CMS-R-131-G) may be used for most situations, including laboratory tests. A separate form (CMS-R-l31 -L) is available for physician-ordered laboratory tests.

Complete ABN instructions will be formally published in the Medicare carriers manual and relevant provider manuals. Publication by Dec. 31, 2001, is planned. Even so, labs and physicians may switch to the new ABN forms right away.

CMS makes clear that it is the laboratory's responsibility to execute an ABN if a physician orders a lab test, and the lab does both the specimen collection and the lab test/processing. That's because "the laboratory has the risk of financial liability in the case of a denial," the agency maintains.

In situations where the physician orders a lab test and the specimen collection is done in the physician's office, and then sent to the lab for processing, CMS says the lab is still responsible for executing the ABN because the laboratory has the risk of financial liability in the case of a denial. Nevertheless, CMS encourages physicians to execute ABNs in these situations, "since the physician has the better opportunity to give notice."

If the physician does not execute the ABN, the lab may contact the beneficiary to execute an ABN in person or by telephone, with an immediate mail notice follow up. In addition, if the beneficiary was given an ABN in person but refuses to sign it, the beneficiary "will be held financially liable in case of a denial," says CMS. In this situation, the lab must collect and maintain specific documentation of the beneficiary's refusal to sign. For more on the ABN and to view copies of the standardized ABN forms, visit: www.bcfa.gov/medlearn/refalm.btm.

New website for consumers

A number of professional laboratory organizations and companies have produced a new website to help consumers understand the many clinical laboratory tests that are part of routine care. Called "Lab Tests Online," the site provides useful information on understanding a comprehensive list of lab tests. It also gives information on conditions and diseases. You can check out the site by going to www.labtestsonline.org.

Joan Szabo is a Washington, DC, freelance writer specializing in healthcare issues. She has been writing the "Washington Report" column for MLO for the past four years.