ABN Update

By Melissa Jacobson, Director of Insurance Billing

In January 2021, the Centers for Medicare and Medicaid Services (CMS) revised the Advanced Beneficiary Notice of Non-coverage (ABN) Form.

The ABN Form CMS-R-131 is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied. The biggest change to the ABN is the special guidance that was added for people who are dually enrolled in both Medicare and Medicaid (QMB). When a provider fills out the ABN for QMB patients, they must instruct the patient to choose Option 1, and they must change the wording as specified in the ABN instructions:

How Medicare Wants the Document Changed for QMB Patients

Strike through Option Box 1 as Provided Below:

OPTION 1. You may ask to be paid now, but I also want Medicare billed for an official decision on payment, which is sent to me on a Medicare Summary Notice (MSN). I understand that if Medicare doesn’t pay, I am responsible for payment, but I can appeal to Medicare by following the directions on the MSN.

Anytime there is the possibility of transferring financial liability to the Medicare patient, it is critical to have the correct version of the ABN on file. Without a signed copy of the current ABN, Medicare providers who bill patients for noncovered services can be found in violation of their Medicare Provider Contract and run the risk of facing financial penalties.

The 2021 ABN update replaces the ABN Form that was last released in June 2017. It can be found here.

Instructions on how to fill out the 2021 ABN updated form can be found on the same website.