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