FFS ABN | CMS

This collection provides the standardized Advance Beneficiary Notice of Noncoverage (ABN) forms (Form CMS-R-131) required by the Centers for Medicare & Medicaid Services (CMS). These forms are used by healthcare providers, physicians, and suppliers to notify Original Medicare (Fee-For-Service) beneficiaries when Medicare is unlikely to cover a specific item or service, allowing the beneficiary to make an informed decision about whether to proceed and accept financial responsibility. The archive includes versions in English and Spanish, as well as large print formats to ensure compliance with accessibility standards.

1. ABNEnglish_508_v2029.docx (Standard English ABN Form) 2. ABNSpanish_508_v2029.docx (Standard Spanish ABN Form) 3. ABNEnglishLargePrint_508_v2029.docx (Large Print English ABN Form) 4. ABNSpanishLargePrint_508_v2029.docx (Large Print Spanish ABN Form)

This collection provides the standardized Advance Beneficiary Notice of Noncoverage (ABN) forms (Form CMS-R-131) required by the Centers for Medicare & Medicaid Services (CMS). These forms are used by healthcare providers, physicians, and suppliers to notify Original Medicare (Fee-For-Service) beneficiaries when Medicare is unlikely to cover a specific item or service, allowing the beneficiary to make an informed decision about whether to proceed and accept financial responsibility. The archive includes versions in English and Spanish, as well as large print formats to ensure compliance with accessibility standards.

1. ABNEnglish_508_v2029.docx (Standard English ABN Form) 2. ABNSpanish_508_v2029.docx (Standard Spanish ABN Form) 3. ABNEnglishLargePrint_508_v2029.docx (Large Print English ABN Form) 4. ABNSpanishLargePrint_508_v2029.docx (Large Print Spanish ABN Form)