Advance Beneficiary Notices
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, plays a significant role within the laboratory testing process for both labs and facilities. It is often used in cases where a patient or resident may not have insurance, suspects a denial, or wishes to take responsibility for any payment.
The Centers for Medicare & Medicaid Services (CMS) hold well-established guidelines regarding what is considered medically necessary within the realm of testing, so ABN forms avoid issues like “surprise billing” by making it clear to the beneficiary that they may have to pay for a test if Medicare will not pay for it. For example, if Medicare denies payment due to overutilization, Aculabs will bill the facility unless an ABN signed by the beneficiary was provided.
In the event a patient is insistent on having a lab test performed, and there is no medically necessary diagnosis according to Medicare, a signed ABN should be provided in advance.
An ABN form is valid for up to one year from the date of service and covers only the lab tests specified on the form.