Waivers: ABNs and Notices of Noncoverage
The Omnibus Budget Reconciliation Act of 1986 (OBPA) included a limitation of liability (or waiver of liability) provision that provides beneficiaries with protection from liability when they, in good faith, receive services from a Medicare provider for which Medicare payment is subsequently denied as not "reasonable and necessary."
The beneficiary is not responsible for services that are not covered by Medicare until he or she has been notified in writing that the services are noncovered services. When an item or service is not covered, the Medicare beneficiary, or his or her representative, must be advised in writing prior to furnishing the item or service. Reasons for Noncoverage include:
- Laboratory tests that will be denied according to the Fiscal Intermediary Local Medical Review Policies.
- Laboratory tests that are not yet FDA approved (investigational tests).
- Laboratory tests that are specifically excluded by the Medicare program. (General Health Panels, Cross-Linked N-Telopeptides)
- Routine or Screening Services. As a courtesy, please inform your patient these services are not covered by Medicare.
Please provide the laboratory with a Notice of Noncoverage or an Advance Beneficiary Notice (ABN) when you have reason to believe Medicare may deny a procedure as "medically unnecessary."