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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.


Ohio Recovery Housing Operators Beware: House Bill 58 Seeks to Make Major Changes

Ohio House Bill 58 proposes significant changes to recovery housing oversight, granting ADAMH Boards authority to inspect and investigate recovery residences. The bill also introduces a Certificate of Need (CON) program, requiring state approval for major facility changes. OMHAS will assess applications based on cost, quality, accessibility, and financial feasibility. The bill also establishes a recovery housing residence fund to support inspections. For more information, contact BMD attorneys Daphne Kackloudis or Jordan Burdick.

January 2025 Notice of Proposed Rulemaking Brings Notable Changes to HIPAA Security Rule

In January 2025, the U.S. Department of Health and Human Services proposed amendments to the HIPAA Security Rule, aiming to enhance cybersecurity for covered entities (CEs) and business associates (BAs). Key changes include mandatory compliance audits, workforce training, vulnerability scans, and risk assessments. Comments on the proposed rule are due by March 7, 2025.

Corporate Transparency Act Effective Again

The federal judiciary has issued multiple rulings on the enforceability of the Corporate Transparency Act (CTA), which took effect on January 1, 2024. Previously, enforcement was halted nationwide due to litigation in Smith v. U.S. Department of the Treasury. However, on February 18th, the court lifted the stay, reinstating the CTA’s reporting requirements. Non-exempt entities now have until March 21, 2025, to comply. Businesses should act promptly to avoid civil penalties of $591 per day and potential criminal liability.

Status Update: Physician Noncompete Agreements in Ohio

Noncompete agreements remain enforceable in Ohio if they meet specific legal requirements. While the AMA and FTC have challenged these restrictions, courts continue to uphold reasonable noncompete provisions for physicians. Recent cases, like MetroHealth System v. Khandelwal, highlight how courts may modify overly restrictive agreements to balance employer interests with patient care. With ongoing legal challenges to the FTC’s proposed ban, Ohio physicians should consult a healthcare attorney before signing or challenging a noncompete agreement.

Immigration Orders and Their Economic Impact on Small Business: Insights from Attorney and Former Immigration Judge Rob Ratliff

President Trump's recent executive orders, targeting immigration policies, could significantly impact small businesses in Ohio, particularly those owned by undocumented immigrants. With stricter visa vetting, halted refugee admissions, and potential deportations, these businesses face uncertainty, workforce disruption, and closures. Ohio's immigrant-owned businesses, especially in food services and transportation, contribute billions to the state economy, and any disruption could result in economic ripple effects.