The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, remains a critical compliance tool for home health providers participating in Original Medicare (fee-for-service, FFS). When used correctly, the ABN protects providers from financial liability while ensuring patients are fully informed about their coverage and potential out-of-pocket costs.

With a newly updated form now in effect, providers should take this opportunity to review ABN requirements, reinforce internal processes, and ensure timely compliance with CMS guidance.

What Is the ABN and When is it Used?

The ABN is issued to Medicare beneficiaries when a provider expects that Medicare will deny payment for a specific item or service. Its primary purpose is to transfer potential financial liability to the beneficiary in situations where coverage is not anticipated.

Home health agencies, along with physicians, practitioners, hospices, suppliers, and independent laboratories, are required to use the ABN in appropriate circumstances involving Original Medicare beneficiaries.

Common scenarios in home health where an ABN may be appropriate include:

• Services that may not meet Medicare’s medical necessity criteria
• Situations where a patient no longer qualifies for home health eligibility (e.g., no longer homebound)
• Reduction or discontinuation of services due to coverage limitations
• Services that fall outside the Medicare benefit

Guidelines for proper issuance are outlined in Section 50 of the Medicare Claims Processing Manual (Pub. 100-04, Chapter 30).

Key Requirements for a Valid ABN

To be enforceable, the ABN must meet specific CMS requirements:

• Issued prior to furnishing the service or item
• Clearly explains why Medicare is expected to deny payment
• Includes a good-faith estimate of the expected cost
• Provides the beneficiary with sufficient time to consider their options
• Must be signed and dated by the beneficiary or authorized representative
• A copy must be retained in the patient’s record

Failure to properly issue a valid ABN may result in the provider being financially responsible for the denied service.

2026 Update: New ABN Form Now in Effect

On March 13, 2026, the Office of Management and Budget (OMB) approved the updated control number for Form CMS-R-131. CMS has released a revised version of the ABN and notified providers through its website and the Medicare Learning Network.

What Providers Need to Know:

• The updated ABN is effective immediately
• The new form expires March 31, 2029
• Providers may continue using the previous version through May 12, 2026

Providers must fully transition to the updated ABN form no later than May 12, 2026. Use of outdated forms after this date may result in compliance issues and an inability to transfer liability to the beneficiary.

Access the updated ABN forms in English and Spanish, along with detailed completion instructions, by clicking here.