by Marty Kotlar, DC, CPCO, CBCS •
President of Target Coding •
Question: Dr Kotlar, “I heard a new ABN form has been released. Can you explain what I need to know about the updated ABN form?”
Answer: ABN stands for Advance Beneficiary Notice of Non-coverage. This form must be provided to Medicare Part B patients prior to delivering a Medicare-covered service. Its purpose is to notify the patient that Medicare is likely to deny payment for a specific item or service due to medical necessity, even though that same service might be covered under different circumstances. This allows patients to make informed decisions about whether to proceed with care that they may need to pay for out-of-pocket or through other insurance. Chiropractic maintenance care is the most common reason an ABN is issued. However, an ABN should only be used when there is a legitimate reason to believe Medicare may deny the claim. The form must be reviewed verbally with the patient or their representative, all questions should be answered, and once completed, the original is retained by the provider while a copy is given to the patient.
If a valid ABN is not issued when required, the provider cannot bill the patient and may be held financially responsible if Medicare denies the claim. ABNs must not be issued routinely without a reasonable basis. Simply stating that Medicare may deny any service at any time is not sufficient justification. A reasonable basis exists when the provider understands Medicare guidelines and believes the service in question may not meet them.
The updated ABN form was approved by the Office of Management and Budget (OMB) on March 13, 2026, and is effective immediately, with an expiration date of March 31, 2029. Providers may continue using the previous version temporarily but must transition to the revised form no later than May 12, 2026. Failure to comply may prevent shifting financial responsibility to the patient for denied services.
While the revised ABN does not introduce major policy changes, it focuses on improving clarity and patient understanding. CMS has enhanced the layout and language to make the form more user-friendly, helping beneficiaries better understand potential coverage denials, affected services, and estimated costs.
The updated form retains the three standard beneficiary options: receive the service and bill Medicare, receive the service and pay out-of-pocket without submitting a claim, or decline the service altogether. These choices remain essential for preserving patient autonomy and informed decision-making.
From an operational perspective, providers should take steps to ensure compliance by updating electronic health record (EHR) systems, replacing outdated forms, and training staff on the revised format. It is also critical that the ABN is completed accurately, including a clear service description, a valid reason for possible denial, and a good faith cost estimate.
It is important to note that ABNs apply only to Original Medicare (Part B) and should not be used for Medicare Advantage (Part C) or Part D services. Additionally, ABNs are required only for services that may be denied as not “reasonable and necessary,” not for those that are statutorily excluded from coverage.
In summary, the 2026 ABN update reflects CMS’s continued effort to improve transparency and patient comprehension without significantly changing the form’s core purpose. Although the revisions are subtle, timely implementation is critical to ensure compliance, protect revenue, and keep patients fully informed of their financial responsibilities.
Email info@targetcoding.com for more information.
MARTY KOTLAR, DC, CPCO, CBCS, is the President of Target Coding. Over the last 15 years, Target Coding has helped hundreds of healthcare providers with compliance as it relates to billing, coding, documentation, Medicare & HIPAA. Dr. Kotlar is certified in compliance, a certified coding specialist, a contributing author to many coding and compliance publications and a guest speaker at many state association conventions. He can be reached at 1-800-270-7044, www.TargetCoding.com or drkotlar@targetcoding.com.
