Final answer:
The Advance Beneficiary Notice of Noncoverage (ABN) is the form that Medicare requires when a service is not covered. It notifies the patient about potential out-of-pocket payments for the service in question. The ABN is part of the fee-for-service model, contrasting with HMO structures and connects to concepts like adverse selection.
Step-by-step explanation:
The form that Medicare requires healthcare providers to use when Medicare does not pay for a service or is likely not to pay for a service is known as an Advance Beneficiary Notice of Noncoverage (ABN). The ABN is a written notice that providers must give to a Medicare beneficiary before providing services or items that are expected to be denied by Medicare.
The ABN is part of the fee-for-service (FFS) payment model where healthcare providers are reimbursed for each service rendered. This model contrasts with the approach used by Health Maintenance Organizations (HMOs), where reimbursement is per patient, not service. The concept of adverse selection also relates to this topic and refers to scenarios where individual knowledge about health risks can influence behaviors, leading high-risk individuals to seek more comprehensive insurance coverage.