Medicare Revises Form For Coverage Of Beneficiaries' Medical Care

The Health Care Financing Administration is asking for comments on a newly revised form given annually to millions of Medicare beneficiaries before they receive a medical service that Medicare may not pay for. 

HCFA, which administers Medicare, has developed a one-page version of the form, called the advance beneficiary notice, to make it more readable and easier-to-understand. The revised form is available on the HCFA Web site at http://www.hcfa.gov/regs/prdact95.htm.   Simplifying the advance beneficiary notice was among the top five priority issues recently identified by doctors for HCFA to address. 

In a notice published April 20 in the Federal Register, beneficiaries, health care providers and others are requested to send their comments on the advance beneficiary notice in the next 30 days to the Office of Management and Budget (OMB). (The address for comments is: OMB Human Resources and Housing Branch, New Executive Office Building, Room 10235, Washington, D.C. 20503. Attention: Wendy Taylor). 

HCFA had asked for comments in an earlier notice in the Federal Register on Oct. 26, 2000, and used that input to help revise the form. 

"Advance notices are given out each year to beneficiaries who may not know whether Medicare will pay for their particular medical service," HHS Secretary Tommy G. Thompson said.  "We want to hear suggestions and recommendations to help us improve these forms so Medicare beneficiaries know what the paper they are given really means." 

A doctor or medical equipment supplier may notify a beneficiary that Medicare probably will not pay for a service or an item.  If a beneficiary still wants to get that service, the beneficiary will be asked to sign an agreement that the patient will pay for the service if Medicare does not pay for it. 

The revised form alerts beneficiaries they need to decide whether they want to receive medical items or services which may not be reimbursable. 

The form says: "Medicare does not pay for all of your health care costs. Medicare only pays for covered items and services when Medicare rules are met.  The fact that Medicare may not pay for a particular item or service does not mean that you should not receive it.  There may be a good reason your doctor recommended it.  Right now, in your case, Medicare probably will not pay" for the item or service. 

The form also advises the beneficiary to ask for a further explanation if it is unclear why Medicare probably will not pay and to check how much the item or service will cost, either out-of-pocket or through other insurance. 

The beneficiary then is asked to check one of two options, and sign and date the form. The first option says, "yes, I want to receive these items or services" and the second option says, "no, I have decided not receive these items or services."