Obtaining Advance Beneficiary Notices for Medicare Physician Providers

by Darren Carter, M.D.
Medicare has established medical necessity rules that define the medical conditions that make beneficiaries eligible for particular services. These rules are codified in local medical review policies (LMRPs) that are established by Medicare claims payment contractors. If a beneficiary?s provider does not inform the patient that a service may not be covered, the provider cannot subsequently bill the beneficiary for the service if it is denied.