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  renewed form  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:

  1. Physicians, providers (including institutional providers like nursing homes and outpatient hospitals), practitioners, and suppliers paid under Part B (including independent laboratories);
  2. Hospice providers and religious non-medical health care institutions (RNHCIs) paid exclusively under Part A; and
  3. 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:

  1. The form must be issued on a single page that is legal or letter size.
  2. 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.
  3. You must insert header information.
  4. One of the check boxes in the Option Box section must be selected by the beneficiary/representative.
  5. 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.
Our clinical consulting team members can lend support by helping you develop an easy to follow process for ensuring your ABNs are completed correctly and timely. We provide on-site and remote educational sessions to the team members responsible for completing ABNs. For additional assistance contact your ACT representative or email us at .