August 2026 Monthly AFCNA Webinar-ABNEnglish_508_v2029

ABNEnglish_508_v2029_LARGE PRINT

Pdf Summary

This document is the Medicare Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131. It informs Original Medicare beneficiaries that Medicare may not pay for a listed item, test, service, or care, so the patient may be responsible for the cost.<br /><br />The form includes spaces to describe:<br />- the item/service,<br />- the reason Medicare may not pay,<br />- and the estimated cost.<br /><br />It asks the patient to read the notice, ask questions, and choose one of three options:<br />1. Receive the service and have Medicare billed for an official payment decision. If Medicare denies payment, the patient may appeal and may be responsible for the bill.<br />2. Receive the service but do not bill Medicare. The patient agrees to pay and cannot appeal because Medicare is not billed.<br />3. Do not receive the service. The patient is not responsible for payment and cannot appeal.<br /><br />The notice also states that it is not an official Medicare decision, but the provider’s opinion. It provides the Medicare help line and explains that the patient has the right to accessible formats and to file a discrimination complaint.<br /><br />The bottom section is a legal and administrative disclosure under the Paperwork Reduction Act, explaining why the form exists, who must use it, and that completing it usually takes less than seven minutes.

Keywords

Medicare

Advance Beneficiary Notice

ABN

CMS-R-131

non-coverage

Original Medicare

patient responsibility

billing decision

appeal rights

Paperwork Reduction Act