ABN Standards

50.5 - ABN Standards (Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21) The ABN, Form CMS-R-131, is the OMB approved standard written notice. Failure to use this notice as mandated could result in the notice being invalidated and/or the notifier being held liable for the items or services in question. The online replicable copies of the OMB approved ABN (CMS-R-131) and instructions for notice completion are available on the CMS website at: http://www.cms.gov/Medicare/Medicare-General- Information/BNI/ABN.html A. Language Choice The ABN is available in English and Spanish under a dedicated link on the web page given above. Notifiers should choose the appropriate version of the ABN based on the language the beneficiary best understands. Insertions must be in English when the English language ABN is used. Similarly, when a Spanish language ABN is used, the notifier should make insertions on the notice in Spanish, if applicable. In addition, verbal assistance in other languages may be provided to assist beneficiaries in understanding the document. However, the printed document is limited to the OMB-approved English and Spanish versions. Notifiers should document any types of translation assistance that are used in the “Additional Information” section of the notice. B. Effective Versions ABNs are effective as of the OMB approval or expiration date given at the bottom of each notice. The routine approval is for 3-year use. Notifiers are expected to exclusively use the current version of the ABN. CMS will allow a transition period for healthcare providers and suppliers to switch from using expiring notices to newly approved notices. C. General Notice Preparation Requirements Number of Copies A minimum of two copies, including the original, should be made so the beneficiary and notifier each have one. The notifier should retain the original whenever possible. Reproduction Notifiers may reproduce the ABN by using self-carbonizing paper, photocopying, digitized technology, or another appropriate method. All reproductions should conform to applicable requirements. Length and Size of Page The ABN form must not exceed one page in length; however, attachments are permitted for listing additional items and services. If attachments are used, they should allow for clear matching of the items or services in question with the reason and cost estimate information. The ABN is designed as a letter- sized form. If necessary, it may be expanded to a legal-sized page. Contrast of Paper and Print A visually high-contrast combination of dark ink on a pale background should be used. Do not use reversed print (i.e. white print on black paper), or block- shaded (highlighted) text. Font Fonts as they appear in the ABN downloaded from the CMS web site should be used. In cases where changes need to occur, notifiers should use alternative fonts that are easily readable, such as Arial, Arial Narrow, Times New Roman, and Courier. Any other changes to the font, such as italics, embossing, bold, etc., should not be used since they can make the ABN more difficult to read. The font size generally should be 12 point. Titles should be 14-16 point, but insertions in blanks of the ABN can be as small as 10 point if needed. Information inserted by notifiers in the blank spaces on the ABN may be typed or legibly hand-written. Customization Notifiers are permitted to do some customization of ABNs, such as pre- printing information in certain blanks to promote efficiency and to ensure clarity for beneficiaries. Notifiers may develop multiple versions of the ABN specialized to common treatment scenarios, using the required language and general formatting of the ABN. Blanks (G)-(I) must be completed by the beneficiary when the ABN is issued and should not be pre-filled. Lettering of the blanks (A-J) should be removed prior to issuance of an ABN. If pre-printed information is used to describe items/services and/or common reasons for non-coverage, the notifier must clearly indicate on the ABN which portions of the pre- printed information are applicable to the beneficiary Healthcare providers or suppliers who pre-print a menu of items or services may wish to list a cost estimate alongside each item or service. Modification The ABN may not be modified except as specifically allowed by these instructions. Notifiers must exercise caution before adding any customizations beyond these guidelines, since changing ABNs too much could result in invalid notice and healthcare provider or supplier liability for non-covered charges. Validity judgments are generally made by Medicare contractors, usually when reviewing ABN-related claims; however, any complaints received may be investigated by contractors and/or CMS central or regional offices.