JotPsych Notes: video

Medicare won't accept an Advance Beneficiary Notice your staff signed

When Medicare may deny a service as not medically necessary or too frequent, your patient or a representative signs and dates the notice before the service.

Nate Peereboom
Co-founder, JotPsych

Medicare may not pay for your patient's next service, and your staff hand over the Advance Beneficiary Notice (ABN). Who signs it decides whether you can bill your patient.

A WPS narrator on who signs an Advance Beneficiary Notice

a video by WPS Government Services, a Medicare contractor, 3 minutes

WPS Government Services, “Advance Beneficiary Notice of Noncoverage (ABN) Signature Guidance,” September 30, 2026, 3 minutes. https://www.youtube.com/watch?v=YgAvTixhbKU

WPS Government Services processes Medicare claims for Iowa, Kansas, Missouri, Nebraska, Indiana, and Michigan. The narrator covers when the notice needs a signature, who may sign it, and what to do when a patient refuses.

The guidance from a WPS narrator holds in every state, because every clinician who bills original Medicare uses the same notice, Form CMS-R-131, per Medicare's notice booklet.

Decide before the visit whether the notice is required. You need it when Medicare may find the service not medically necessary for your patient's condition, or past a Medicare frequency limit, the narrator says at 0:45. For services Medicare never covers, the notice is optional (0:19).
Get the signature before the service starts. Your patient or a representative signs and dates the notice, and a representative adds "rep" or "representative" after the signature, the narrator says at 1:33. When the need for the notice comes up mid-visit, "stop and provide the ABN before moving forward," the narrator says at 1:09.
Don't let your staff sign for your patient. When a provider or the provider's staff signs for the patient, "Medicare does not consider this a valid signature," the narrator says at 1:44. Medicare doesn't accept a verbal yes your staff write down, either (1:55).
Write down a refusal, and consider holding the service. Note on the form who refused, and when (2:45). Medicare's notice booklet says to consider not giving the service, unless your patient's health or safety would suffer. You may list a witness, but the booklet doesn't require one.
Bill with the right modifier, and keep the notice 5 years. GA marks a required notice on file, and GZ marks an expected denial with no notice. Count the years from the date of care. Keep refused notices, too.

Signatures Medicare accepts on a required Advance Beneficiary Notice

per a WPS video of September 30, 2026, and Medicare's notice booklet, MLN006266, May 2025

Valid

Signed by the patient

Or by a representative, who adds "rep"

Dated

Signed before the service

Not valid

Signed by you or your staff for the patient

A verbal yes, written down by staff

Medicare can hold your practice liable when a required notice is missing or invalid, per its notice booklet. A notice signed after the service can't transfer that liability to your patient.

Our view

Plan the notice with the visit. Mark the services that may fall outside coverage when you schedule, so your patient signs before the session starts. Then file the signed copy.

Upload each signed notice to the patient's Documents section in JotPsych, which titles and types the file.

Book 15 minutes

Sources:

WPS Government Services, "Advance Beneficiary Notice of Noncoverage (ABN) Signature Guidance," YouTube, September 30, 2026, 3 minutes, narrated by WPS provider outreach and education; quotes from WPS's own English captions.
Centers for Medicare & Medicaid Services, "Medicare Advance Written Notices of Non-coverage," MLN006266, May 2025: who gives the notice on page 3, signing and keeping the notice on page 9, refusals and financial liability on page 10, modifiers GA and GZ on page 11.