(1) As noted above, the current Advance Beneficiary Notice
of Noncoverage offers Option 2:"I want the [service] listed above, but do not bill Medicare.
The Medicare program has issued a revised Advance Beneficiary Notice
(ABN) that clinical laboratories and other Part B providers must begin using by no later than September 1 of this year.
Previously, there was no process to reliably determine whether a procedure or service would be considered "reasonable and necessary." Healthcare providers could only offer patients an "advance beneficiary notice
" if they thought this was a possibility.
If you are considering providing a specific service to a Medicare patient (e.g., excision of a facial lesion) and you are not certain that Medicare will pay for the service (Medicare pays for the excision of only malignant skin lesions), you should have the patient sign an Advance Beneficiary Notice
(figure) if you expect to collect some type of payment (this form can be downloaded in PDF format from www.cms.hhs.gov/home/medicare.