Determining Beneficiary Liability in Claims for Ancillary and

130.1.1 - Determining Beneficiary Liability in Claims for Ancillary and Outpatient Services (Rev. 594, Issued: 06-24-05, Effective: 07-01-05, Implementation: 07-01-05) A presumption will be made that the beneficiary did not know that items or services are not covered unless there is evidence to the contrary. Indication on the claim that the beneficiary received proper advance beneficiary notice before receiving the noncovered ancillary, outpatient, or rural health clinic services is evidence to the contrary which rebuts the presumption in the beneficiary’s favor. The definitions of proper “advance beneficiary notice” to the beneficiary are set forth in §40.3. Note that if the reason liability is at issue coincides with the end of coverage for a period of care in specific settings-- inpatient hospital, skilled nursing, home health, hospice or comprehensive outpatient rehabilitation facilities-- notification under the expedited determination process will be required as of July 1, 2005. See CR#3903 for preliminary information on the expedited process, including its interaction with liability notice policy (i.e., ABNs).