What is Medicare Reimbursement?
Medicare reimbursement refers to the amount of money that a hospital or doctor will receive in return for providing services to Medicare beneficiaries. These amounts which is the Medicare fee schedule is determined by federal legislature. This means that they will accept a certain amount of money for each procedure according to Medicare fee schedule.
As of the time of this video over 90% of doctors and physicians accept what’s called Medicare assignment for their services. What that means is that they will accept what Medicare offers as paid in full for services. As of 2017 over 90% of doctors accept assignment. Therefore Medicare Reimbursement saves Medicare a lot of money.
Only 1% of doctors opt out Medicare completely. As a result you you will rarely have to file a claim. This is done electronically when you have Original Medicare. With Medicare Reimbursement, first the bill goes to Medicare and they pay their portion. Next, if you have a supplement it will pick up the difference.
Medicare is not designed to take care of all the costs, as you know. The bill then goes on to the supplement company. The Supplement insurance company follows right behind Medicare. They are not allowed to say no as long as Medicare says it’s a normal Medicare approved procedure and your doctor says that you need it. There’s nobody behind the scenes to say no. It is an automatic process.
Now if you did need to file a claim, we have a specific video for that. Click here for How to file a Medicare claim. You will find that the general guidelines are that you must provide an itemized bill .You need The Patient’s request for medical payment. Access that form by clicking here.
Or we are happy to send you the form by mail. You can also get that from your plan. The form must be filed within one year. It’s necessary to provide the itemized bill and an explanation of why you feel this claim should be paid. So there is a specific procedure to follow. Have a look at our video about filing a claim. We walk you through it very specifically.
So when we’re talking about Medicare reimbursement we’re referring only to original Medicare Part A and Part B. If you have Medicare Advantage you do not have original Medicare. Medicare Advantage is an ALTERNATIVE to Original Medicare. The Medicare Advantage company receives a certain fee every month from the government. You must contact your plan directly. If you don’t get what you need, you can contact the Medicare beneficiary ombudsman.
Thank you for checking out What is Reimbursement in Medicare. We hope this has been informative. We’re happy to help with anything Medicare. Please feel free to give us a call at (888) 506-7510. Or if you are like so many folks that are overwhelmed by the amount of Medicare information, have a look at our 6-Part Medicare mini course. You’ll find that at www.GetMedicareSavings.com.