The Centers for Medicare and Medicaid Services (CMS) recently released an updated version of its Advanced Beneficiary Notice of Non-Coverage (ABN) form. The ABN form is issued by providers and suppliers to Original Medicare beneficiaries in situations where Medicare payment is expected to be denied. Accordingly, the ABN form allows a provider or supplier to collect payment from the Medicare beneficiary if Medicare does deny payment.
The updated form is valid through March 31, 2029, and provides notice to beneficiaries that certain items, tests, or services may be denied by Medicare. As a result, the beneficiary may be financially responsible for payment. The form lists several options for beneficiaries in these circumstances. They may:
- Receive the item, service or test and ask to bill Medicare for an official decision on payment;
- Receive the item, service or test without billing Medicare; or
- Refuse the item, service, or test.
For each option, the form explains who is financially liable.
Providers may continue using the old ABN form until May 12, 2026, at which point all Medicare providers and suppliers must adopt the updated form. The updated form is available in English and Spanish and can be found here, along with detailed instructions. A sample ABN for labs is also included in the link.
Once the ABN form is completed and signed by the beneficiary, a copy should be saved in the medical record and, if requested, provided to the beneficiary or their representative.
Should you wish to receive further information concerning healthcare matters, please contact Gunster's Healthcare Law practice.
This publication is for general information only. It is not legal advice, and legal counsel should be contacted before any action is taken that might be influenced by this publication.
YES! PLEASE SIGN ME UP TO RECEIVE EMAIL ALERTS FROM OTHER GUNSTER PRACTICE AREAS.
Gunster. Florida's Law Firm for Leaders.
As a full-service law firm, Gunster provides legal counsel to leading organizations and individuals from its 13 offices statewide. Established in 1925, the firm has expanded, diversified and evolved, but always with a singular focus: Florida and its clients’ stake in it. A magnet for business-savvy attorneys who embrace collaboration for the greatest advantage of clients, Gunster’s growth has not been at the expense of personalized service but because of it. The firm serves clients from its offices in Boca Raton, Coral Gables, Fort Lauderdale, Jacksonville, Miami, Naples, Orlando, Palm Beach, Stuart, Tallahassee, Tampa, Vero Beach, and its headquarters in West Palm Beach. With more than 320 attorneys and consultants, and 300 committed support staff, Gunster is ranked among the top 200 largest law firms by the National Law Journal and has been recognized as one of the Top 100 Diverse Law Firms by Law360. More information about its practices, industries, offices and news is available at www.gunster.com.
