CMS Pub. 100-04, ch. 30, § 50.8.1

ABNs should be delivered in- person and prior to the delivery of medical care which is

presumed to be non- covered. In circumstances when in -person delivery is not possible,

notifiers may deliver an ABN using another method. Examples include:

• Direct telephone contact;

• Mail;

• Secure fax machine; or

• Internet e-mail.

All methods of delivery require adherence to all statutory privacy requirements under

HIPAA. The notifier must receive a response from the beneficiary or his/her

representative in order to validate delivery.

When delivery is not in-person, the notifier must verify that contact was made in his/her

records. In order to be considered effective, the beneficiary should not dispute such

contact. Telephone contacts should be followed immediately by either a hand-delivered,

mailed, emailed, or a faxed notice. The beneficiary should sign and retain the notice and

send a copy of this signed notice to the notifier for retention in the patient’s record.

The notifier must keep a copy of the unsigned notice on file while awaiting receipt of the

signed notice. If the beneficiary does not return a signed copy, the notifier should

document the initial contact and subsequent attempts to obtain a signature in appropriate

records or on the notice itself.