From: tmartinez@accuchecker.com


Email Newsletter

Coding and Billing Tips / Updates for 2000

May 1, 2000

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GO TO www.AccuChecker.com'S AccuLibrary FOR THE

MOST CURRENT INFORMATION AVAILABLE ON MEDICARE'S WAIVER 
LIABILITY FORM.

READ IMPORTANT INFORMATION ABOUT THE NECESSITY OF THIS 
FORM!



"Waiver Liability"



A Waiver of Liability is an advance written notice to the 
beneficiary that

the physician, provider or supplier believes there is a likelihood 
that the

item/service may be defined as not medically necessary. This 
notice serves

as proof that the beneficiary had knowledge prior to the furnishing 
of the

item/service that the item/service would be denied as not 
medically

necessary and agreed to be financially responsible for the 
item/service. If

a Waiver of Liability was/is not furnished, the physician, provider 
or

supplier could be held liable for the charge if it is determined that 
he/she

knew, or should have known that the item/service would be denied 
as not

medically necessary.

PRINT OR SAVE FORM COPY BELOW



Waiver Liability (WL) & Advanced Beneficiary Notice (ABN) 
Agreement

____________________________________________________
__________



One or more of the procedures or CPT4 codes listed below are 
requested by

the physician, either separately or as part of a panel, profile or 
other

group test group, for

this patient with Medicare coverage AND the patient's diagnosis 
DOES NOT

match

any of the ICD-9 codes established as eligible for coverage  by the 
local or

regional Medicare carrier.



Medicare will only pay for services that it determines to be 
'reasonable and

necessary' under section 1862(a)(1) of the Medicare law.  If 
Medicare

determines

that a particular service, although would otherwise be covered, is 
not

'reasonable

and necessary' under Medicare program standards, Medicare will 
deny payment

for

that service.  I believe that in your care, Medicare is likely to deny

payment for the following service(s):



	Procedure:			CPT4:













For the following REASON:



______Medicare usually does not pay for the service for the 
provided

diagnosis.



______Medicare does not pay for tests that do not have FDA 
approval.



______Medicare usually does not pay for routine exam/lab work



______Other:__________________________________________
__________





I have been notified by my physician/supplier that he/she believes 
that, in

my case, Medicare is likely to deny payment for the services 
identified

above for the reasons noted.  If Medicare denies payment, I AGREE 
to be

personally and fully responsible for payment.







____________________________________
	_____________________________

Beneficiary's Signature	Date





____________________________________
	_____________________________

Beneficiary's Name (PLEASE PRINT)		Beneficiary's 
Insurance #



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I have been informed by my provider that he/she believes, in my 
case,

Medicare under section 1862(a)(1) is likely to deny payment for the 
test(s)

identified above, for the reason stated.  I understand that I have 
the right

to decide whether or not to have the identified procedure(s) 
performed.  I

have decided NOT to have the identified procedure(s) performed 
because I am

not willing to be personally responsible for payment.







_____________________________________	    
_____________________________

Beneficiary's Signature	Date





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