CMS Renews ABN Document
The Advance Beneficiary Notice of Non-coverage (ABN) Form CMS-R-131
has been approved by the Office of Management and Budget (OMB) for renewal. The form is subject to public comment and re-approval every three years. The use of the
will expire on 06/30/2023. Use of this renewed form is mandatory beginning on 8/31/2020. *Dual eligible beneficiaries have been added to the ABN form instructions.
The ABN is a notice given to beneficiaries in Original Medicare to convey that Medicare is not likely to provide coverage in a specific case. Provider settings required to use the form include:
- Physicians, providers (including institutional providers like nursing homes and outpatient hospitals), practitioners, and suppliers paid under Part B (including independent laboratories);
- Hospice providers and religious non-medical health care institutions (RNHCIs) paid exclusively under Part A; and
- Home health agencies (HHAs) providing care under Part A or Part B.
Medicare inpatient hospitals and skilled nursing facilities (SNFs) use other approved notices for Part A items and services. However, they must use the ABN for Part B items and services.
In addition, the ABN may be used to provide notification of financial liability to the patient/resident for items or services that Medicare never covers.
Some important points to remember about issuing ABNs:
- The form must be issued on a single page that is legal or letter size.
- There are 10 blanks for completion in the notice. Entries may be handwritten or typed, but must be at least 12-point font if possible. In blanks where detailed information is given, if space does not allow for 12-point font, you may use 10-point font.
- You must insert header information.
- One of the check boxes in the Option Box section must be selected by the beneficiary/representative.
- The form is to be signed in cursive, with printed annotation if needed.
*Remember, a provider cannot bill dual eligible beneficiaries when an ABN is furnished if the beneficiary chooses to demand bill.