GA - JE Part B

Definition

Waiver of liability statement issued as required by payer. An Advance Beneficiary Notice of Noncoverage (ABN) has been provided to the patient.

Correct Use

• Append when ABN provided and denial expected on an item or service as it is not reasonable and necessary
• Append when ABN provided and provider determines services will not be covered based on an active Local Coverage Determination (LCD)
• Append when ABN provided and if Medicare determines that service is not payable, claim denial is under a "medical necessity denial"

Incorrect Use

• Appending when provider has no expectation that an item or service will be denied
• Appending on a routine basis for all services performed by provider

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Process Manual, Chapter 1, Section 60.4.2
• CMS Change Request (CR) 6563