Revisiting the Basics: The Continued Role of Advance Beneficiary Notices in the Provision of Health Care

• February 27, 2026

• Alissa D. Fleming , Baker Donelson Bearman Caldwell & Berkowitz PC
• Katherine A. Denney , Baker Donelson Bearman Caldwell & Berkowitz PC

An advance beneficiary notice of noncoverage (ABN) is a written notice that Medicare providers (e.g., independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers must give to Medicare fee-for-service beneficiaries before delivering items or services that they expect Medicare will not cover. The notice enables patients to make informed decisions about whether to receive the service and accept financial liability if Medicare denies coverage. Simultaneously, it gives providers, physicians, practitioners, and suppliers the ability to effectively transfer potential financial liability and encourages them to have systems in place to identify areas of noncoverage on the front-end of an interaction with a Medicare fee-for-service beneficiary. This process and documentation continue to play an important role in avoiding overpayment determinations and potential sanctions and should be an important feature in providers’ and suppliers’ compliance programs to ensure they adequately navigate complex and changing coverage criteria.

ARTICLE TAGS

• In-House Counsel Practice Group
• Government Reimbursement