Question

If a sevice fails to support medical necessity requirements per the LCD, and the service is not covered, the practice would be responsible for obtaining a(n)

Answer 1

When a service fails to meet the Local Coverage Determination (LCD) for medical necessity and is not covered, the practice must obtain an Advance Beneficiary Notice of Noncoverage (ABN) to inform the patient of potential costs.

Step-by-step explanation:

If a service fails to support medical necessity requirements per the Local Coverage Determination (LCD), and the service is not covered, the practice would be responsible for obtaining a Advance Beneficiary Notice of Noncoverage (ABN). The ABN is a written notice that a provider should give to a Medicare beneficiary before providing a service or item that Medicare is expected not to pay for. The ABN serves to notify the patient that they may be responsible for the payment, and it allows them to make an informed decision about whether to receive the service and accept financial responsibility.