An Advance Beneficiary Notice of Noncoverage (form CMS-R-131) is given to a Medicare patient before a service that Medicare may not cover. If signed, it allows the provider to bill the patient if Medicare denies the claim.
Without a valid ABN, the provider usually cannot bill the patient for a service Medicare denies as not medically necessary.
Related terms
- Medical necessity
- The requirement that a service is reasonable and needed for the patient's condition.
- Claim denial
- A payer's decision not to pay a claim that it received and processed.
- Patient responsibility
- The part of a bill the patient owes: copay, deductible, coinsurance and non-covered services.