With a May 12, 2026 deadline to transition to updated Advance Beneficiary Notice (ABN) forms, providers should take this opportunity to revisit CMS’s strict requirements and the risks associated with improper use. While the revisions focus primarily on readability and design, CMS’s underlying rules remain unchanged, and enforcement remains rigorous. With denial rates on claims using the ABN-related GA modifier reaching 42% in 2024, ABNs are far more than a routine administrative formality.
In a recent article with Part B News, Guillermo Beades cautions that even minor missteps can have significant financial consequences for providers.
“While most practices treat the form as a routine administrative hurdle, CMS maintains strict standards for the ABN to be enforceable. Even minor deviations can invalidate the notice, leaving a practice financially responsible for denied claims.”
Guillermo also emphasizes that ABNs must be used selectively and correctly—issued only when there is a clear, justifiable reason to expect a denial and presented to patients at the appropriate time—warning against using the form as a blanket safeguard or altering its required format.
Read the full article with Part B News (subscription required).
