Crosswalk

CROSSWALK DOCUMENT FOR CHANGES TO CMS-R-131
(Advance Beneficiary Notice of Non-Coverage)
SUBMITTED FOR COLLECTION
SUMMARY OF CHANGES TO CMS-R-131: The “Advance Beneficiary Notice of
Non-coverage (ABN)” is issued to Original Medicare (fee for service - FFS) by
providers (including independent laboratories, home health agencies, and hospices),
physicians, practitioners, and suppliers to beneficiaries in situations where Medicare
payment is expected to be denied in certain instances (e.g. not medically reasonable and
necessary under Section 1862(a)(1)(A)). In order for the provider, physician,
practitioner, and supplier to transfer potential financial liability, an ABN must be issued
to the Original Medicare FFS beneficiary to inform them prior to providing the item or
service in question. The ABN was initially approved with the 2023 PRA submission;
however, with this submission, there is plain language and information design, nonsubstantive changes to the form and form instructions. There are no changes that will
affect existing ABN users.
The following non-substantive changes have been made to the form:
•
•

The form has been revised to include plain language and minor information
design changes. New headings were added in plain language to break up the
form for readability. See enclosed documents for changes.
The PRA disclosure statement was placed on the bottom of the ABN form to
reflect a single page document. See enclosed documents for changes.

The following non-substantive changes have been made to the form
instructions:
•

The form instructions have been revised to provide consistent instructions regarding
the changes to the form. See enclosed documents for changes.

The ABN is an existing collection and is in use. It is our expectation that the nonsubstantive changes to the form and form instructions will have little effect on burden
for all users. The Office of Communications (OC) recommendations are soundly based
on research-based best practices in plain language and information design. Along with
decades of research in cognitive science and behavioral economics, OC draw from a
wealth of research data specific to CMS programs. The OC has been conducting
consumer research with patients, caregivers, providers and partners who interact with
CMS programs for more than 20 years, and they use feedback from this research to
make sure the information and products are clear and easy to use. Consumer testing is
ongoing, and OC iteratively refine language and design standards as our audiences and
their information needs evolve. The OC work to apply the same research-based
standards across all products and channels to make sure our language, messaging and
branding are consistent.
1