Non PAR provider with Medicare question

[Ruthie1972]

Hello,
We are a lab company that deals with providers who OPT out of Medicare. They are charging their patients cash for their services then referrning to our lab for urine and oral tests. We are getting denials due to the provider not being PECOS registered.

Do the patients need to sign an ABN form in order for us to get reimbursement? DO we also send the ABN form to the secondary insurance if they have one?

Thank you for your responses.

[Michele]

Providers who are not enrolled in Medicare cannot refer/order services.  They must be in PECOS to be on the claim as the ordering/referring provider.

[PMRNC]

Michele is correct. My providers have all either opted out or don't take Medicare. It's up to the lab to determine eligibility / and billing on those patients.