Medicare Claims Processing Manual (Pub. 100-04), Ch. 30 § 50.8.1
Options for Delivery Other than In-Person
50.8.1- Options for Delivery Other than In-Person
(Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21)
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.