Genova Diagnostics is a participant in the Medicare program. Genova Diagnostics will file claims directly with Medicare, on behalf of patients, if:
For tests not considered diagnostic by Medicare, EasyPay Schedule B is recommended. These are indicated as statutorily excluded tests on the Advance Beneficiary Notice (ABN) or by a notice of non-coverage by Medicare included the kit. Medicare patients may choose our EasyPay Schedule B option when:
The Medicare program requires that the patient be given a form called an Advanced Beneficiary Notice (ABN) for certain tests. The ABN is included in applicable test kits and should be reviewed carefully by the patient.
The ABN is mandated by Medicare to:
The ABN must be obtained prior to sending the test sample/specimen. To be completed properly, the ABN must have the beneficiary's name indicated at the top, must have an option selected with a check or "x", and must be signed and dated by the patient. The ABN must be sent with the requisition and test sample/specimen. Medicare regulations require the covered party to be given a copy of the signed ABN by the practitioner's office.
Genova Diagnostics has taken a proactive role in Medicare Compliance. We fully support federal regulations to enforce financial and professional integrity and to ensure that tests ordered under Medicare reimbursement meet the standards of "medical necessity."
All claims submitted to Medicare for Genova Diagnostics' laboratory services must be for tests that are medically necessary. "Medically necessary" is defined as a test or procedure that is reasonable and necessary for the diagnosis or treatment of illness or injury, or to improve the functioning of a malformed body member. Consequently, tests performed for screening purposes will not be reimbursed by the Medicare program. Health care practitioners may deem it medically necessary to order a single test or a portion of a test profile.
Medicare Advantage plans will be processed through the EasyPay program. Based on the plan provider, either EasyPay Schedule A or EasyPay Schedule B will be used. Please see EasyPay Schedule B list for Medicare Advantage insurance providers that are eligible for EasyPay Schedule B. For all other Medicare Advantage insurance providers NOT listed on the EasyPay Schedule B list, please see the EasyPay Schedule A guidelines.
Please Note: Some Medicare Advantage plans assign substantial out-of-pocket expenses for Genova's services. Medicare Advantage patients who are covered by a EasyPay Schedule B insurance provider should consider whether they want to receive services from Genova Diagnostics, especially those services that have a likelihood of resulting in substantial out-of-pocket expenses.
Genova Diagnostics only files claims with Medicaid programs in the following states:
Health care practitioners must be authorized to order or refer laboratory services according to Medicaid program guidelines.
Medicaid patients may choose our EasyPay Schedule B option if they are receiving testing services in any other state not listed above.