In it's zeal to catch providers who keep resubmitting claims until they find an ICD-9 diagnosis code that pays, the Centers for Medicare and Medicaid Services is placing the burden on Clinical Laboratories to acquire an ABN when the diagnosis does not meet the Medical Necessity guidelines CMS has initiated.
As of July 5th 2005, Medicare will no longer allow the review of previously denied claims.
MuirLab has an NCD manual available to physicians to help them with coding the 23 tests that CMS is monitoring. Once the claim has been denied the Lab cannot re-bill, which means your patients will have to pay. It is imperative that we receive the qualifying diagnosis when the order is placed.