Since 1972, providers have been required to notify Medicare beneficiaries when outpatient services may not be covered by Medicare. The ABN provisions are located in section 1879 of the Social Security Act (Public Law 92-603), 42 CFR §411.404 and §411.408.

An Advance Beneficiary Notice of Non-Coverage (ABN) is a written notice given to a Medicare beneficiary by a physician, provider, or supplier when he or she believes that Medicare will deny some or all of the services or items because of medical necessity or the frequency of the service.

The ABN is not designed for use when Medicare never covers a service. An ABN should be used if Medicare does cover the service for some diagnoses, but the provider believes it will not be covered for a particular situation.

Medicare Part B has combined the two different ABN forms and the Notice of Exclusions from Medicare Benefits (NEMB) form into a new form CMS-R-131 for providers to use.

The provider must complete the following fields:

• Top of the form: Notifiers, Patient Name, Identification Number
• Center of form: List items, Reason for Denial, and Cost