Advance Beneficiary
Notice of Noncoverage (ABN), Form CMS-R-131
This article is based on Change Request (CR) 8404 which provides: 1)
instructions for Home Health Agency (HHA) use of the Advance Beneficiary Notice
of Noncoverage (ABN) to replace the outgoing Home Health Advance Beneficiary
Notice (HHABN), Form CMS-R-296, Option Box 1; 2) ABN issuance guidelines for
therapy services and therapy specific examples; and 3) minor editorial changes
to clarify existing manual instructions regarding ABN issuance.
Home health agencies and therapy providers should make sure that their health
care and billing staff are aware of these ABN policy changes. All other
providers should note that there have been no substantive changes to the ABN
form or general instructions for issuance and can reference MM7821 (available
at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/mm7821.pdf)
for general ABN information.
HHA Use of ABN – General Use
HHAs are required to issue an ABN to Original Medicare beneficiaries in
specific situations where “Limitation on Liability” (LOL) protection is
afforded under Section 1879 of the Act for items and/or services that the HHA
believes Medicare will not cover (see Table 1 below). In these circumstances,
if the beneficiary chooses to receive the items/services in question and
Medicare does not cover the home care, HHAs may use the ABN to shift liability
for the non-covered home care to the beneficiary.
