Form CMS-R-131. FFS ABN

Form CMS-R-131, also known as the Advance Beneficiary Notice of Noncoverage (ABN), is a notice that healthcare providers give to Medicare beneficiaries to inform them that Medicare may not pay for a particular service or item they are receiving, and that the beneficiary may be responsible for paying for it. The purpose of the ABN is to help beneficiaries make informed decisions about their healthcare and understand their financial liability.

The ABN consists of several parts, including the beneficiary's name and Medicare number, the service or item that may not be covered, the reason why it may not be covered, and an estimate of the cost of the service or item. The beneficiary is required to sign the ABN to acknowledge that they have received and understand the notice.

Important fields on the ABN include the Healthcare Common Procedure Coding System (HCPCS) code for the service or item, the reason why Medicare may not cover it, and the estimated cost. Providers must also indicate whether the beneficiary has the option to receive the service or item without Medicare coverage.

When compiling the ABN, providers must ensure that all required fields are completed accurately and that the beneficiary is given a copy of the notice. Providers may also need to attach additional documentation, such as a physician's order, to support the need for the service or item.

Examples of when the ABN may be used include when a beneficiary receives a service or item that is not covered by Medicare, or when the provider believes that Medicare may not cover the service or item for a specific reason, such as medical necessity.

Strengths of the ABN include its ability to inform beneficiaries of their financial liability and help them make informed decisions about their healthcare. Weaknesses include the potential for confusion or misunderstanding, as well as the possibility of beneficiaries being charged for services or items that they believed would be covered by Medicare.

An alternative form to the ABN is the Notice of Medicare Non-Coverage (NOMNC), which is used when Medicare coverage for a service or item is ending. The main difference between the ABN and NOMNC is that the ABN is used when Medicare may not cover a service or item, while the NOMNC is used when Medicare coverage is ending.

The ABN is an important tool for both providers and beneficiaries in ensuring that Medicare beneficiaries receive the appropriate care and understand their financial liability. The form is submitted to the beneficiary for acknowledgement and stored in the provider's records as proof of notification.