Diagnosis: Regulations
• An Advanced Beneficiary Notice of Noncoverage must be provided by independent laboratories.
• The Advance Beneficiary Notice of Noncoverage was formerly named the “Advance Beneficiary Notice.”
• The law requires a provider to notify a beneficiary in advance if the service will likely be denied as “not reasonable and necessary.” If an Advance Beneficiary Notice of Noncoverage is not given, providers may not bill Medicare or the individual patient for these services.
• Medicare is a health insurance program for people 65 years or older, people younger than 65 years with certain disabilities, and people of all ages with end-stage renal disease.
• Medicaid is a joint state-federal-administered health insurance program that provides health coverage for income-qualifying individuals. To participate in Medicaid, federal law requires states to cover certain population groups.
