Advance Beneficiary Notice of Noncoverage (ABN)
An ABN, Form CMS-R-131, is a standardized notice that a health care provider/supplier must give to a Medicare beneficiary, before providing certain Medicare Part B or Part A items or services.
It must be issued when the health care provider (including independent laboratories, physicians, practitioners and suppliers) believes that Medicare may not pay for an item or service because of medical necessity, frequency limitations, discontinued services, experimental and investigational, and not safe or proven effective.
It gives a beneficiary the opportunity to make an informed decision prior to the procedure or service being rendered to decide whether to receive the service and accept financial responsibility if denied by Medicare and serves as proof that the beneficiary had knowledge prior to receiving the service that Medicare might not cover. If the provider does not deliver a valid ABN to the beneficiary when required, the beneficiary cannot be billed for the service and the provider may be held financially liable.
An ABN must not be used for all services and is not required for services that are statutorily excluded. Such as: vitamins, nutritional counseling, x-rays, office visit, and therapy.
A Single ABN is acceptable when:
- ABN identifies all items/services and duration of period of treatment
- No treatment changes have ocurred
- Services have not been added/deleted
If there are ANY changes, a new ABN is required.
- Noncovered Charges for Outpatient Claims
- Notification Requirements for Noncovered Charges
- Preventive Screening Benefits ABN Requirements
- Services Excluded By Statute
- FFS SNF ABN and SNF Denial Letters
- FSS Hospital Issued Notice of Noncoverage (HINNs)
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 30
Last Updated May 09, 2017