September 11, 2008
Revised form CMS-R-131 advance beneficiary notice of noncoverage
Effective Date: March 3, 2008
Implementation Date: March 1, 2009
Summary
Prior to March 3, 2008, physicians, providers, practitioners, and suppliers paid under Part B, and hospice providers and religious nonmedical health care institutions paid under Part A, were instructed to use the general advance beneficiary notice (ABN-G) or laboratory advance beneficiary notice (ABN-L) to inform beneficiaries of their potential liability in accordance with the limitation on liability provisions set forth in Section 1879 of the Social Security Act.
Beginning on March 3, 2008, CMS implemented use of the revised ABN of noncoverage. This revised ABN combines the ABN-G and the ABN-L into a single notice, with the same form number (CMS R-131).
The Medicare Claims Processing Manual chapter 30 (Financial Liability Protections), section 50 (Form CMS-R-131 Advance Beneficiary Notice of Noncoverage (ABN)) has been substantially updated to reflect these changes. A total of 85 subsections have been deleted from this chapter, and 47 are either new or have been revised. Attached to change request (CR) 6136 is the updated chapter 30 and the Web address for viewing CR 6136 is contained in the “Additional Information” section of this article.
The following situations require by statute that an ABN be issued:
• Care is not reasonable and necessary
• There was a violation of the prohibition on unsolicited telephone contacts
• Medical equipment and supplies supplier number requirements not met
• Medical equipment and/or supplies denied in advance
• Custodial care
• A hospice patient who is not terminally ill.
Source: CMS MLN Matters Article MM6136
