August 2026 Monthly AFCNA Webinar-ABNEnglish_508_v2029

ABNEnglish_508_v2029_Fillable

Pdf Summary

This document is the Medicare Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. It is used by providers to warn a Medicare beneficiary that Medicare may not pay for a specific item, test, service, or care the patient is about to receive. If Medicare denies payment, the patient may be responsible for the cost.<br /><br />The form asks the provider to list the item/service, the reason Medicare may not pay, and the estimated cost. The patient is instructed to read the notice, ask questions, and then choose one of three options:<br /><br />1. Receive the service and have Medicare billed for an official coverage decision. If Medicare does not pay, the patient may need to pay, but can appeal.<br />2. Receive the service without billing Medicare. The patient pays and cannot appeal Medicare’s decision because Medicare was not billed.<br />3. Decline the service. The patient is not responsible for payment and cannot appeal.<br /><br />The notice emphasizes that it is only the provider’s opinion and not an official Medicare determination. It also provides Medicare contact information for questions, explains that the signature confirms receipt and understanding, and states the patient can request the form in accessible formats or file a discrimination complaint if needed.<br /><br />The final section is a Paperwork Reduction Act disclosure explaining the legal basis for the form, its OMB control number, the estimated completion time, and where to send comments about the form.

Keywords

Medicare

Advance Beneficiary Notice

ABN

CMS-R-131

non-coverage

beneficiary responsibility

coverage decision

provider notice

appeal rights

Paperwork Reduction Act