The use of written notices to inform
beneficiaries of their liability under specific conditions has been
available since Title XVIII of the Social Security Act (the Act),
section 1879, Limitation On Liability, was enacted in 1972 (P.L.
92-603). Similar required notification and liability protections
are available under other sections of the Act: section 1834(a)(18)
refund requirements for certain items when unsolicited telephone
contacts are made, section 1834(j)(4) for the same types of items
when there is neither a required advance coverage determination nor
required supplier number; 1834(a)(15) also for advance
determinations for these items and section 1842(l) applicable to
physicians not accepting assignment. Implementing regulations are
found at 42 CFR 411.404(b) and (c), and 411.408(d)(2) and (f), on
written notice requirements. These statutory requirements apply
only to Original Medicare, not Medicare Advantage plans. The notice
used to fulfill this requirement was originally referred to as an
"Advance Notice." Eventually, the term "Advance Beneficiary Notice"
abbreviated as "ABN" became more popular; ABN became standard usage
in 1996. The general ABN notice last received OMB approval under
the Paperwork Reduction Act of 1995 (PRA) in 2003. In seeking
renewal of OMB's approval, CMS is retaining the widely-known ABN
acronym, but it is changing the official title to "Advance
Beneficiary Notice of Noncoverage" in order to more clearly convey
the purpose of the notice, and also to make this title more
consistent with other similar notices, such as the Hospital Issued
Notice of Noncoverage (HINN). Note that previous OMB approval was
for two versions of the ABN, the General Use ABN, form CMS-R-131-G,
and CMS-R-131-L, specifically for physician-ordered laboratory
tests. These versions have now been combined into a single notice
meeting both needs and satisfying all pertinent regulatory
requirements. Under section 1879 of the Act, Medicare beneficiaries
may be held financially responsible for items or services usually
covered under Medicare, but denied in an individual case under
specific statutory exclusions, if the beneficiary is informed prior
to furnishing the issues or services that Medicare is likely to
deny payment. When required, the ABN is delivered by Part B paid
physicians, providers (including institutional providers like
outpatient hospitals) practitioners (such as chiropractors), and
suppliers, as well as hospice providers and Religious Non-medical
Health Care Institutions paid under Part A. Other Medicare
institutional providers paid under Part A use other approved notice
for this purpose.
US Code:
42
USC 1395pp Name of Law: Limitation on liability of beneficiary
where medicare claims are disallowed
US Code: 42
USC 1395m Name of Law: Special payment rules for particular
items and services
US Code: 42
USC 1395u Name of Law: Provisions relating to the
administration of Part B
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Response to 30-Day Comments Final-OMB 1-24.doc
30-day CMS-R-131 Comments #10 thru #31 from OMB.pdf
Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408