What's New
April 4, 2023: The ABN, Form CMS-R-131, and form 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 01/31/2026 will be mandatory on 6/30/23. You may continue to use the ABN form with the expiration date of 6/30/23 until the renewed form (expiration date 01/31/2026) becomes mandatory on 6/30/23. The ABN form and instructions may be found in the table below.
January 23, 2023: The MOON and IM/DND have received OMB approval and the updated versions, as well as general information on the notices, are now available at the following links.
MOON https://www.cms.gov/medicare/medicare-general-information/bni/moon
IM/DND https://www.cms.gov/medicare/medicare-general-information/bni/hospitaldischargeappealnotices
Both Medicare beneficiaries and providers have certain rights and protections related to financial liability and appeals under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers. Use the navigation links on the left side of this page or in the table below to access the financial liability, appeal and other notices and their instructions.
- FFS Advance Beneficiary Notice of Noncoverage (FFS ABN)
- FFS Home Health Change of Care Notice (FFS HHCCN)
- FFS Skilled Nursing Facility Advance Beneficiary Notice (FFS SNF ABN)
- FFS Hospital-Issued Notices of Noncoverage (FFS HINNs)
- FFS Expedited Determination Notices for Home Health Agencies, Skilled Nursing Facility, Hospice and Comprehensive Outpatient Rehabilitation Facility (FFS Expedited Determination Notices)
- MA Denial Notices (MA Denial Notices)
- MA Expedited Determination Notices (MA Expedited Determination Notices)
- Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) (Hospital Discharge Appeal Notices)
- Medicare Outpatient Observation Notice (MOON)
|
Notice |
Medicare Program |
Type of Notice |
Provider Type |
Purpose |
Link to Notice |
|
Advance Beneficiary Notice of Non-coverage (ABN, Form CMS-R-131) |
FFS |
Financial Liability Notice |
Healthcare providers (including independent laboratories, HHAs, and hospices), physicians, practitioners, and suppliers paid under Medicare Part B |
Issued in order to transfer financial liability to beneficiaries to convey that Medicare is not likely to provide coverage in a specific case. |
ABN, (ZIP)Form CMS-R-131 (ZIP)
|
|
Home Health Change of Care Notice (HHCCN, Form CMS-10280) |
FFS |
Care Changes |
HHAs |
Issued to beneficiaries receiving home health care benefits for notification of plan of care changes. |
|
|
Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN, Form CMS-10055) |
FFS |
Financial Liability Notice |
SNF |
Issued in order to transfer financial liability to beneficiaries before the SNF provides an item or service that is usually paid for by Medicare, but may not be paid for in this particular instance because it is not medically reasonable and necessary, or is custodial in nature. |
SNF ABN, Form CMS-10055 (DOCX)
|
|
Hospital-Issued Notices of Non-coverage (HINNs) |
FFS *HINN 10 may be used for MA |
Financial Liability Notices |
Hospitals |
Issued in order to transfer financial liability to beneficiaries if the hospital determines that the care the beneficiary is receiving, or is about to receive, is not covered in a specific case. There are currently four different HINNs. |
|
|
Notice of Medicare Non-Coverage (NOMNC, Form CMS-10123) |
FFS & MA |
Expedited Determination Notices |
HHAs, SNFs, Hospices, and CORFs |
Informs beneficiaries of their discharge when their Medicare covered services are ending. |
|
|
Detailed Explanation of Non-Coverage (DENC, Form CMS-10124) |
FFS & MA |
Expedited Determination Notices |
HHAs, SNFs, Hospices, and CORFs |
Given only if a beneficiary requests an expedited determination. Explains the specific reasons for the end of covered services. |
|
|
Important Message from Medicare (IM, Form CMS-10065) |
FFS & MA |
Hospital Discharge Appeal Notices |
Hospitals |
Informs hospitalized inpatient beneficiaries of their hospital discharge appeal rights. |
IM, Form CMS-10065 (ZIP) |
|
Detailed Notice of Discharge (DND, Form CMS-10066) |
FFS & MA |
Hospital Discharge Appeal Notices |
Hospital or MA Plan |
Given only if a beneficiary requests expedited review of a discharge decision. Explains the specific reasons for the discharge. |
|
|
Integrated Denial Notice (IDN, Form CMS-10003) |
MA |
Denial Notices |
Medicare Health Plans |
Issued upon denial, in whole or in part, of an enrollee's request for coverage and upon discontinuation or reduction of a previously authorized course of treatment. |
IDN, Form CMS-10003 Spanish (ZIP)
|
|
Medicare Outpatient Observation Notice (MOON) |
FFS & MA |
Hospital notice of observation services and are not inpatients |
Hospital or MA Plan |
Issued to inform Medicare beneficiaries (including health plan enrollees) that they are outpatients receiving observation services and are not inpatients of a hospital or critical access hospital (CAH). |
|
Medicare Outpatient Observation Notice (MOON)
Information on the MOON can be found using the left navigation menu.
Questions?
Questions regarding any of the Fee For Service BNI notices, the Medicare Advantage notices, and the MOON can be submitted at: https://appeals.lmi.org