Which form is required so the patient knows she may be responsible for payment for a Medicare service?

• A. Advanced Beneficiary Notice
• B. Consent to treat
• C. Medical release
• D. Authorization form

Answer: (A)

When a Medicare service might not be covered, the patient must be informed in advance about the possibility of paying out of pocket. The form used for this is the Advanced Beneficiary Notice. It is given before the service so the patient understands she may be responsible for payment if Medicare denies or doesn’t cover the service, and it gives her a choice to proceed and accept the potential charge or decline. The other forms serve different purposes: consent to treat is general permission to perform care, a medical release is for sharing medical records, and an authorization form is for authorizing access to or release of information.