The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, and instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of June 30, 2023 will be mandatory on Aug. 31, 2020.   

The ABN form and instructions may be found on this CMS webpage. Click on “ABN Form Instructions (PDF)” to download. 

Skilled nursing facilities issue form CMS-R-131 to transfer potential financial liability for items/services expected to be denied under Medicare Part B only. The ABN for Part A services is CMS-10055 and is available here.