Medicare Advanced Beneficiary Notice Explained: When & How to Use It

If you’re in the healthcare industry and dealing with Medicare patients, you need to understand Medicare Advanced Beneficiary Notice Forms (ABNs)—otherwise, you might be leaving money on the table or setting yourself up for financial headaches.

Too many providers don’t even realize Medicare ABN forms exist or why they’re necessary. But if you offer services that Medicare might not cover, you need to be using these forms properly. Let’s break it all down so you can protect your practice, your patients, and your revenue.

Key Takeaways:

Medicare ABNs notify patients when a service may not be covered, shifting financial responsibility.
They must be given before providing the service—not after.
Failure to provide a proper ABN means you can’t bill the patient if Medicare denies the claim.
Medicare Advantage plans don’t use ABNs—each insurer has its own form.
Training staff is crucial to avoid claim denials and revenue loss.

What Are Medicare Advanced Beneficiary Notice Forms?

A Medicare ABN form is essentially a waiver of liability that informs a Medicare patient that a certain service may not be covered by Medicare. If the patient chooses to proceed, they accept financial responsibility for the cost.

You can easily find the latest version of the Medicare ABN form by searching online, but be sure you’re using the most updated version. In April 2023, CMS released a new version that is valid for three years. Using outdated forms could cause billing issues.

Who Needs to Use Medicare Medicare Advanced Beneficiary Notice Forms?

If you’re a doctor’s office, laboratory, home health agency, or hospice provider, you should be using Medicare Advanced Beneficiary Notice Forms when providing services that Medicare might not cover.

Here’s the key: You must give the patient the form before services are rendered.

That means before the appointment or procedure, not after.
If the patient is caught off guard by a bill later, they may dispute the charge, and you might be forced to eat the cost.
If Medicare denies the claim and the patient didn’t receive a properly completed ABN form, they could argue they didn’t understand the financial responsibility.

And guess what? CMS might side with them, leaving you unpaid for services you already provided.

How to Fill Out Medicare ABN Forms Correctly

The Medicare ABN form is straightforward, but filling it out correctly is crucial.

Here’s what you need to include:

The service that may not be covered.
Why it might not be covered.
The estimated cost to the patient.
The patient’s choice:
- Proceed with the service and accept financial responsibility.
- Decline the service to avoid the cost.

Once the form is complete, the patient must sign and date it before you move forward with the service.

Medicare ABNs vs. Medicare Advantage Plans

One huge mistake providers make is assuming Medicare ABNs apply to Medicare Advantage plans.

They don’t.

Medicare Advantage plans have their own versions of ABN-like forms, but they aren’t called ABNs and vary by insurer. If you accept Medicare Advantage plans like UHC, Blue Cross, or Aetna, you need to contact each carrier to find out what documentation they require.

Not using the correct form could mean you won’t get paid.

What Happens If You Don’t Use Medicare Advanced Beneficiary Notice Forms Correctly?

Messing up Medicare ABN forms can be a costly mistake. If you fail to provide an ABN when required, or if the form is incomplete, unreadable, or missing critical details, it could be deemed invalid.

Here’s what could happen:

Medicare denies the claim—and because there’s no valid ABN on file, you can’t bill the patient.
The patient appeals the charge, claiming they didn’t understand their financial responsibility. If CMS sides with them, you won’t get paid.
If your form is unclear or lacks enough notice, CMS may rule that you must absorb the cost of the service—meaning you just provided free healthcare (and not by choice).

This is why it’s critical to train your staff on the correct use of Medicare Advanced Beneficiary Notice Forms and ensure every form is filled out properly before services are provided.

When You DON’T Need a Medicare Medicare Advanced Beneficiary Notice Form

While Medicare ABNs are essential in many cases, you don’t always need one.

According to CMS guidelines, here are situations where an ABN isn’t required:

If Medicare is expected to cover the service based on current coverage rules.
If the patient has secondary insurance that will cover the cost (though it’s still good practice to inform the patient).
If the service is statutorily excluded from Medicare coverage, meaning Medicare never covers it under any circumstances (in this case, you simply bill the patient directly).
Emergency situations, where obtaining a signed ABN isn’t feasible before providing critical care.

However, even if an ABN isn’t legally required, it’s still a good idea to communicate costs to patients upfront. Surprise medical bills lead to frustrated patients, lost trust, and complaints.

Using ABNs for Non-Medicare Patients

Although Medicare Advanced Beneficiary Notice Forms are specifically for Medicare patients, you can apply the same concept to commercially insured patients.

Insurance companies deny claims all the time, and many patients have no idea what their insurance actually covers. To avoid surprise bills and frustration, many practices use a similar waiver of liability for commercial insurance patients.

Here’s how that helps:

Patients are made aware of potential out-of-pocket costs upfront.
They can decide whether to proceed before receiving a surprise bill.
It prevents billing disputes and improves transparency in your practice.

If you frequently offer services that insurance might not cover, consider creating a custom financial responsibility form for your non-Medicare patients. Clear communication is key.

How to Train Your Staff on Medicare Advanced Beneficiary Notice Forms

You might understand Medicare Advanced Beneficiary Notice Forms inside and out—but does your staff?

If your front desk team, billing department, or medical assistants aren’t properly trained, ABNs can easily be forgotten, misused, or completed incorrectly, leading to denied claims and lost revenue.

Steps to Ensure Your Staff Uses ABNs Correctly

Hold an In-Service Training
Dedicate a staff meeting to reviewing when and how to use Medicare ABNs. Walk through real-life scenarios where an ABN would be needed and explain what happens if one isn’t provided.
Provide a Step-by-Step Guide
Print out a clear, easy-to-follow reference for your team that outlines:
- When an ABN is required
- How to fill it out
- What to say to patients
- Where to store the signed form
Roleplay Conversations with Patients
Staff members need to feel comfortable explaining why a Medicare ABN form is necessary. Practice common patient objections, like:
- “Why do I have to sign this?”
- “Can’t Medicare just cover it?”
- “What if I refuse to sign?”
Regularly Check for Compliance
Randomly audit patient records to ensure ABNs are being completed correctly. If you find mistakes, provide immediate feedback to prevent costly errors.

Training Your Front Office Staff: The Key to a Smooth-Running Practice

Best Practices for Handling Medicare ABN Forms

Using Medicare Advanced Beneficiary Notice Forms isn’t just about getting a signature—it’s about protecting your practice and keeping patients informed.

Here’s how to make sure your ABN process is smooth and effective:

Use the latest ABN version (the 2023 update is valid until 2026).
Give the form with enough notice—don’t just shove it at the patient right before a procedure.
Explain why the form is necessary so the patient doesn’t feel like they’re being tricked into signing something.
Keep signed copies on file for at least five years in case of a dispute.
If in doubt, provide an ABN. It’s always better to have one on file than to assume coverage and later find out Medicare won’t pay.

By making ABNs a routine part of your workflow, you can reduce billing headaches, avoid lost revenue, and improve patient communication.

FAQ: Medicare Advanced Beneficiary Notice Forms

Still have questions about Medicare Advanced Beneficiary Notice Forms (ABNs)? Let’s clear up some of the most common concerns so you can use them correctly and confidently.

What is a Medicare Advanced Beneficiary Notice (ABN)?

A Medicare ABN form is a document that notifies a patient that a service may not be covered by Medicare and allows them to accept financial responsibility if they choose to proceed.

When should I use a Medicare ABN form?

You should use an ABN when you suspect that Medicare will not cover a service due to lack of medical necessity or other coverage restrictions.

For example:

A patient requests a procedure that Medicare usually doesn’t cover.
Medicare has frequency limits on a service, and the patient has already exceeded that limit.
The provider is offering a preventive or elective service not considered essential under Medicare guidelines.

What happens if I don’t give a patient an ABN?

If Medicare denies the claim and you didn’t provide an ABN beforehand, you cannot bill the patient for the service. Instead, you’ll be forced to write off the cost, losing revenue.

Can I use Medicare ABNs for Medicare Advantage plan patients?

No. Medicare Advantage plans have their own version of an ABN, and you must contact each insurance provider (UHC, Aetna, Blue Cross, etc.) to obtain their specific form.

Can a patient refuse to sign an ABN?

Yes, a patient can refuse to sign, but that doesn’t mean you should provide the service for free. If they refuse, you should document their refusal and decide whether to proceed. If you do move forward, you might have to absorb the cost if Medicare denies the claim.

How long should I keep a signed ABN on file?

You should retain Medicare ABN forms for at least five years, as they may be needed for audits or claim disputes.

Do I need to provide an ABN for services that Medicare never covers?

No. If a service is statutorily excluded from Medicare coverage, you do not need an ABN. You can simply bill the patient directly.

What’s the latest version of the Medicare ABN form?

The most recent updated ABN form was released in April 2023 and is valid for three years (until 2026). Make sure you’re using the latest version to remain compliant.

Should I use an ABN-like form for non-Medicare patients?

Yes! Many practices create their own financial responsibility waivers for commercial insurance patients, ensuring they understand potential out-of-pocket costs.

Can I email an ABN form to a patient for a digital signature?

Medicare does not explicitly prohibit digital ABN signatures, but the safest approach is to obtain a physical signature in person whenever possible. If using digital methods, ensure compliance with Medicare guidelines.

Final Thoughts on Medicare ABNs

Medicare won’t always cover every service you provide, and Medicare Advanced Beneficiary Notice Forms ensure that your patients know their financial responsibility upfront.

If you’re running a medical practice, staying ahead of these requirements is essential for maintaining cash flow and avoiding costly claim denials.

Train your staff, use ABNs properly, and keep your financials protected. Your patients (and your bottom line) will thank you.