Medicare Reimbursement Process
Medicare claims are usually sent directly from the Medicare providers to Medicare and Medicare pays the Medicare providers in line with the program’s reimbursement rates. In some special cases, an individual may seek services from a Medicare provider who does not accept Medicare assignments. Here, one has to register the claims in order to be reimbursed. A provider will only accept the Medicare Assignment if he or she has a contract with Medicare and has approved to the repayment rates approved by Medicare for medical services. However, if a Medicare provider fails to accept Medicare assignment, one may have to pay the entire amount upfront and claim for repayment. Medicare reimbursements rates are set by federal legislation to determine how much a provider will receive from Medicare to provide services. To file for claim, one will need to fill a Patient’s Request for Medical Payment form with an itemized bill from a provider to the Medicare contractor (Anderson, 2009). An individual must have reasons why he or she received services from the medical provider, specify the health problem and give more information on any insurance one may have.
Difference between Medicare Insurance Companies
Medicare reimbursements are payments hospitals and doctors receive for services provided to patients covered by Medicare although doctors can choose to accept the rates set by Medicare for services provided while Medicaid does not pay individuals but has a program that sends payments to health care providers. Commercial health insurance plans require that companies or individuals pay a monthly premium or deductibles before they start receiving benefits.
It is the duty of the billers to ensure that Medicare receives claims. Since this government program is a high-volume payer, billers send claims to Medicaid and Medicare. Billers do not necessarily have to go through clearance so as to send claims.
Anderson, A. (2009). Medicare reimbursement. Medicare.
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