The use of written notices to inform
Medicare 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). 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. 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 no required
advance coverage determination or in the absence of a required
supplier number; 1834(a)(15) 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 is the Advance Beneficiary Notice of Noncoverage (ABN)
which was last approved by OMB under the Paperwork Reduction Act of
1995 (PRA) in 2008. 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.
Statute at
Large: 18
Stat. 1879 Name of Statute: null
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.
Form CMS-R-131 Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408
ABNinstructionrationaleforchange.docx
2011spanishabn508trackchanges.doc
Advance Beneficiary Notice of Noncoverage (ABN) and Supporting Regulations in 42 CFR 411.404 and 411.408