Advance Beneficiary Notice of Noncoverage (ABN)
Physicians and other individuals authorized by law to order laboratory tests have the authority to order any test(s) which they deem medically necessary. However, if the test(s) is not covered by Medicare, Medicaid or other federally funded programs, the laboratory may seek payment from the patient.
According to the waiver of liability section of the Medicare Claims Processing Manual, a signed ABN should be obtained from a patient prior to laboratory testing when there is reason to believe payment of the claim may be denied for any of the following reasons: screening, medical necessity (unpayable or no diagnosis provided), frequency, experimental testing, research-only testing or non-FDA approved procedures.
An explanation of the ABN and notification of potential personal financial liability must be given to the patient. The patient should have the option to refuse the services.