Medicare has announced it has come out with a new “Advance Beneficiary Notice of Non-Coverage Form,” or ABN, which is effective immediately.

There is a lot of confusion around ABNs. An ABN informs a Medicare client that Medicare may not cover a particular item or service, and that the client may be personally responsible for the cost. By issuing the ABN, the provider preserves the right to bill the client if Medicare denies the claim.

When do you use it? According to my favorite Medicare expert, Susan Frager of PsychBillingCoach.com, “if you accept Original Medicare and you are charging a Medicare client for a non-covered service, you’re not in compliance unless the client signs an ABN.”

Some Medicare providers assume they must formally opt out of Medicare to offer non-covered services. This is not always the case. The ABN form allows Medicare providers some flexibility to provide non-covered services without having to opt out. [What exactly is a non-covered service? To read more about this, click here]

However, some providers think that an ABN can be used if a Medicare client wants to self-pay. A client may want to waive or bypass billing Medicare (perhaps due to privacy concerns) and pay the provider out of pocket. But Frager states “Medicare is absolutely inflexible on this – self-paying is NOT allowed when a client sees a clinician enrolled as a Medicare provider, even if the client initiates the request to self-pay.” So an ABN cannot be used in this situation.

The ABN form recently was updated and can be downloaded here. While the new form can be used immediately, you can keep using the current one until April 12, 2026 if you wish. But the new ABN must be in use by May 13, 2026 – including for clients who previously signed an older version of the ABN.

Also, an ABN is NOT the form to use if you have formally opted-out of Medicare and a Medicare client wants to pay you privately. That form is a Medicare Private-Pay Contract (see example here from Noridian Medicare).

Want more information about this topic?

• For more information about ABNs, visit the CMS website here
• To read more about why Medicare clients can’t self-pay, click here
• Check out Frager’s webinar “Untangle the Medicare Participation Dilemma” available here