The U.S. Office of Management and Budget (OMB) has published an updated Form CMS-R-131, Fee for Service Advanced Beneficiary Notice of Noncoverage. Between now and June 30, 2023, providers can use the newly published form, which has an expiration date of January 31, 2026, or the current form, which expires June 30, 2023. After June 30, use of the new form is mandatory.
The ABN is used by certain providers[1] to advise patients with Original Medicare (i.e., non-Medicare Advantage) when certain services may not be paid by Medicare. The form includes the reason Medicare may not pay for the service and provides the patient’s estimated cost. It must be delivered to the patient prior to services being performed. Patients who choose to proceed with the service and sign the ABN may be billed by the provider if Medicare does not pay for the service.
Additional information regarding the ABN and use of modifiers on claims can be found in the Medicare Advance Written Notices of Non-coverage (PDF).
PYA has professionals experienced in medical practice operations, billing, and regulatory compliance. If you have questions about ABNs – including how they should be included in your operations or how to select the appropriate modifier for claims filing – our executive contacts would be happy to assist. You may email them below or call (800) 270-9629.
[1] “Providers” includes independent laboratories, home health agencies, hospice, physicians, practitioners, and suppliers.