Medicare/Medicaid Information

The Centers for Medicare & Medicaid Services (CMS), formerly known as HCFA, limits laboratory reimbursement for testing of Medicare/Medicaid patients to tests that are deemed "medically necessary". These regulations impact the physicians who order tests as well as the laboratories that perform them. Laboratories which perform these tests are obligated to inform their clients that:

Physicians should only order tests they believe are medically necessary for their patients;
A test profile may include tests for which Medicare and Medicaid will deny payment;
Physicians should only order individual tests or a less inclusive profile when not all the tests in the standard profile are medically necessary for an individual patient; and
The Department of Health and Human Services, Office of Inspector General (OIG) considers that a physician who orders medically unnecessary tests may be subject to civil penalties.

We have designed materials that should help your office staff comply with these regulations when ordering FBR testing on your Medicare beneficiaries. These include:

FBR Block Tests: Orders for Medicare/Medicaid Patients - a Q & A sheet which explains how to order FBR Block tests on Medicare beneficiaries;
Medicare Update on Medical Necessity Guidelines - as they pertain to FBR testing;
FBR laboratory requisitions - designed to document medical necessity, and incorporating an Advance Beneficiary Notice (ABN) form.
The FBR Requisition:- a guide for using the form;
Important Information for Medicare Beneficiaries - which you are encouraged to photocopy and distribute to your Medicare patients and which summarizes the Medical Necessity and Advance Beneficiary Notice (ABN) concepts; and
A new FBR Test Listing and Fee Schedule.

Please take a few minutes to review this information, which is provided as part of FBR's Compliance Plan. If you have any questions about the above information or would like a hard copy of these materials mailed to you, please don't hesitate to contact us