Medicare to require new Advance Beneficiary Notice of Noncoverage form

When you expect Medicare to deny payment (e.g. because the service is being provided more frequently than Medicare allows or because the diagnosis is not one covered by Medicare) an Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is useful for maximizing collections. A new version of the form will soon be required.

You use the ABN to inform beneficiaries that they may be financially liable for the service before they receive it, and the ABN permits you to collect from the beneficiary if Medicare denies the service as expected.  

The federal Office of Management and Budget recently approved for renewal the ABN, Form CMS-R-131, and the form instructions. Use of the renewed form (with the expiration date of June 30, 2023) will be mandatory starting Aug. 31.  

The ABN form and instructions may be found on the Centers for Medicare & Medicaid Services’ website. Guidelines for issuing the ABN can be found beginning in Section 50 in the Medicare Claims Processing Manual, 100-4, Chapter 30. Questions regarding the ABN can be submitted at https://appeals.lmi.org/

— Kent Moore, Senior Strategist for Physician Payment at the American Academy of Family Physicians