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CMS Requires Providers to Use an Updated Advance Beneficiary Notice (ABN) Form by May 12, 2026

Client Alert

The Centers for Medicare & Medicaid Services (CMS) has issued an UPDATED version of the Advance Beneficiary Notice of Noncoverage (ABN), Form CMS‑R‑131, which providers and suppliers must begin using no later than May 12, 2026.  A copy of the form can be found here

An ABN is a written notice provided to traditional Medicare beneficiaries to inform them that the items services that they are receiving will likely be denied by Medicare as non-covered.  This must be provided by the provider to the Medicare beneficiary in advance of the items or services so that the beneficiary can decide whether to proceed with the items or services, which will most likely require the beneficiary to pay out of pocket.

What Has Changed?

The revised ABN does not substantially alter Medicare coverage policy or when an ABN must be issued. All previous rules and guidance remain in effect.  Instead, CMS has focused on improving the clarity and usability of the form, including:

  • Simplified, plain‑language instructions to better communicate potential financial liability to patients;
  • Streamlined formatting and improved layout for readability; and
  • Revised beneficiary option language to make decision-making clearer.

The updated form is approved for use through March 31, 2029.

Critical Compliance Deadline

CMS has permitted a limited transition period; however, all providers must discontinue use of prior versions of the ABN after May 12, 2026.

Failure to use the current ABN form on or after this date may render the notice invalid, which can prevent providers from charging the patient if Medicare denies the claim and the provider attempts to collect payment from the patient.   

Key Reminders for Providers:

  • The ABN must be issued prior to furnishing items or services when coverage is expected to be denied.
  • It applies to traditional Medicare (fee‑for‑service) beneficiaries, not Medicare Advantage plans.
  • Providers must ensure the form is properly completed, signed, and retained to support billing compliance.
  • Ensure all forms are updated (including paper and electronic versions). 
  • Ensure all staff members are properly trained. 

For questions regarding the updated ABN requirements or assistance with compliance and implementation, please contact Vice President and Akron Managing Partner Amanda Waesch at alwaesch@bmdllc.com or Paralegal Tracy Miller at trmiller@bmdllc.com.


Medicare Updates: Prior Authorizations and Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) has announced two key updates effective January 1, 2026: a six-state prior authorization pilot program targeting high-risk services under the WISeR Model, and proposed revisions to the Physician Fee Schedule (PFS) that include increased payment rates, expanded telehealth coverage, and updated policies for chronic care, behavioral health, and rural providers.

USCIS Policy Updates: Implications for Business Immigration

In August 2025, USCIS issued three key policy updates enhancing vetting, good moral character (GMC) evaluations, and scrutiny of "anti-American" conduct in immigration adjudications. These policy memos will impact employers sponsoring foreign workers, including H-1B, L-1, EB visas, adjustments, and naturalization.

Ohio Passes Antidiscrimination Provision for CRNA Reimbursement

Ohio has passed House Bill 96, introducing a provider nondiscrimination provision that requires health plans to reimburse certified registered nurse anesthetists (CRNAs) at the same rate as physicians for the same services. The law aims to improve patient access to care by eliminating payment discrimination against CRNAs and will take effect on September 30, 2025.

Ohio Board of Pharmacy | Administrative Code Rule Changes

The Ohio Board of Pharmacy (“BOP”) recently posted notices of Ohio Administrative Code rule changes related to record keeping and the sale and distribution of certain ephedrine-containing products.

A Shift in Coverage: HHS Reinterprets “Federal Public Benefit” Under PRWORA

The U.S. Department of Health and Human Services rescinded a 1998 interpretation of “federal public benefit” used in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) on July 10, 2025. This notice removes "outdating exclusions" and includes additional programs under “federal public benefit."