Advance Beneficiary Notice of Noncoverage (ABN)-Spanish - DIGITAL FORM
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UPDATED April 2023 following the OMB (Office of Management and Budget) approval for renewal. The CMS-R-131 ABN now expires 1/31/2026.
This renewed ABN will be mandatory for use on 6/30/2023. The renewal form may be used/issued prior to this mandatory deadline.
This Advanced Beneficiary Notice provides the Medicare patient with advance notice of physician-ordered non-covered care. It is also used to notify the patient of reduction or termination of ongoing care when the physician does not concur.
CMS-R-131 is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service - FFS) beneficiaries in situations where Medicare payment is expected to be denied. The ABN is issued in order to transfer potential financial liability to the Medicare beneficiary in certain instances.
Also available in print, customized with your facility information. Call 800-247-2343 to learn more!
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*This this digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment). After 1- year, your update subscription will automatically renew.
Also available in print, customized with your facility information. Call 800-247-2343 to learn more!
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