Advance Beneficiary Notice

An ABN, also known as Form CMS-R-131, is a document informing you that Medicare is unlikely to offer coverage for a specific service, medication or equipment. Note that an ABN isn’t a denial — you can still receive coverage despite receiving an ABN.

On the ABN form, you can decide whether you want the service, medication or equipment and choose your billing preference — or you can decide to decline altogether.

The purpose of an ABN form is to transfer potential financial responsibility to the Medicare beneficiary if needed. The U.S. Centers for Medicare & Medicaid has a sample ABN form available to help you gain familiarity. Even though an ABN form is only one page, you should still read each line carefully. Once signed, you can become legally responsible if Medicare denies payment.

You can receive an ABN from one of your physicians, providers, home health agencies, hospice providers or lab specialists. ABNs are only valid if they are given to you in advance. This way, you have time to make a premediated health care decision. An ABN will never be required in an emergency.

There are different types of ABNs depending on your circumstance. While they all have slight differences in functionality, they all generally serve the same purpose — to notify you about potential Medicare coverage issues.

An ABN has multiple sections with information relevant to your service or treatment.

Your full name will be printed on the form. Whoever gives you the ABN must also provide their full name, address and phone number on the form.

The ABN will have the name of the service or item that might not be covered, the reason why Medicare may not pay, along with the estimated cost.

There are three options in a checklist to consider. What you choose determines if you are getting the treatment or item, as well as your billing decision. You can only choose one option.

You’ll only be subject to an ABN if you are enrolled in Original Medicare, which includes Part A and Part B. If you have Medicare Advantage, also known as Part C, you will not receive an ABN.

It’s also important to note what conditions will likely warrant an ABN. If your Medicare item or service isn’t deemed reasonable or necessary, you could receive an ABN.

Remember, you can only be given an ABN if you have time to consider your options. You cannot be given an ABN if you’re facing an immediate medical emergency. For example, if you’re requesting a service that isn’t immediately necessary — you could be given an ABN. If you’re being rushed into the emergency room with a broken leg — you will not be given an ABN.

To further clarify, you can only be given an ABN if you have Original Medicare and have a considerable amount of time to consider your medical decision.

If you receive an ABN, you should talk over this decision with the provider who gave you the ABN form or another qualified individual. When making an important medical decision, it would be in your best interest to have a professional weigh in their recommendation. You’ll then choose one of the three options listed above.

Once you’ve selected an option, you’ll need to sign and date the form. You, and whoever gave you the form, should each keep a copy of the ABN. The form provider will then submit your ABN.

If Medicare denies coverage or you disagree with their payment decision, then you can file an appeal. If you file an appeal, they could reconsider their decision.

Before you file an appeal, you should gather all relevant information. This will help your chances of being reconsidered.

If you can’t think of a credible reason why your item or service should be covered, then you shouldn’t try to file an appeal. If you can, there are two simple steps to filing your appeal.

After you file your appeal, the response time is typically 60 days. If Medicare decides to cover the item or service previously declined, then the coverage will be listed on your next MSN.